Improves outlook in life WHY I SHOULD EXERCISE?

Increased physical activity can lead to a longer life and improved health. Exercise helps prevent heart disease and many other health problems. Exercise builds strength, gives you more energy and can help you reduce stress. It is also a good way to curb your appetite and burn calories.

WHO SHOULD EXERCISE?

Increased physical activity can benefit almost everyone. Most people can begin gradual, moderate exercise on their own. If you think there is a reason you may not be able to exercise safely, talk with your doctor before beginning a new exercise program. In particular, your doctor needs to know if you have heart trouble, high blood pressure or arthritis, or if you often feel dizzy or have chest pains.

HOW LONG SHOULD I EXERCISE?

Start off exercising 3 or more times a week for 20 minutes or more, and work up to at least 30 minutes, 4 to 6 times a week. This can include several short bouts of activity in a day. Exercising during a lunch break or on your way to do errands may help you add physical activity to a busy schedule. Exercising with a friend or a family member can help make it fun, and having a partner to encourage you can help you stick to it.

IS THERE ANYTHING I SHOULD DO BEFORE AND AFTER EXERCISE?

You should start an exercise session with a gradual warm-up period. During this time (about 5 to 10 minutes), you should slowly stretch your muscles first, and then gradually increase your level of activity. For example, begin walking slowly and then pick up the pace.

After you are finished exercising, cool down for about 5 to 10 minutes. Again, stretch your muscles and let your heart rate slow down gradually. You can use the same stretches as in the warm-up period.

A number of warm-up and cool-down stretching exercises for your legs are shown at the end of this handout. If you are going to exercise your upper body, be sure to use stretching exercises for your arms, shoulders, chest and back.

HOW HARD DO I HAVE TO EXERCISE?

Even small amounts of exercise are better than none at all. Start with an activity you can do comfortably. As you become more used to exercising, try to keep your heart rate at about 60 to 85% of your "maximum heart rate." To figure out your target heart rate, subtract your age in years from 220 (which gives your maximum heart rate), and then multiply that number by 0.60 or 0.85. For example, if you are 40 years old, you would subtract 40 from 220, which would give you 180 (220 - 40=180). Then you would multiply this number by either 0.60 or 0.85, which would give you 108 or 153 (180 x 0.60=108 and 180 x 0.85=153).

When you first start your exercise program, you may want to use the lower number (0.60) to calculate your target heart rate. Then, as your conditioning gradually increases, you may want to use the higher number (0.85) to calculate your target heart rate. Check your pulse by gently resting 2 fingers on the side of your neck and counting the beats for 1 minute. Use a watch with a second hand to time the minute.

HOW DO I AVOID INJURING MYSELF?

The safest way to keep from injuring yourself during exercise is to avoid trying to do too much too soon. Start with an activity that is fairly easy for you, such as walking. Do it for a few minutes a day or several times a day. Then slowly increase the time and level of activity. For example, increase how fast you walk over several weeks. If you feel tired or sore, ease up somewhat on the level of exercise, or take a day off to rest. Try not to give up entirely even if you don't feel great right away! Talk with your doctor if you have questions or think you have injured yourself seriously.

WHAT ABOUT STRENGTH TRAINING

Most kinds of exercise will help both your heart and your other muscles. Resistance training is exercise that develops the strength and endurance of large muscle groups. Weight lifting is an example of this type of exercise. Exercise machines can also provide resistance training. Your doctor or a trainer at a gym can give you more information about exercising safely with weights or machines.

WARM UP and COOL DOWN STRETCHES

1. Calf Stretch
Face a wall, standing about 2 feet away from it. Keeping your heels flat and your back straight, lean forward slowly and press your hands and forehead to the wall. You should feel stretching in the area above your heels (this area is shaded in the picture). Hold the stretch for 20 seconds and then relax. Repeat.

2. Quad Stretch
Face a wall, standing about 1 foot away from it. Support yourself by placing your right hand against the wall. Raise your right leg behind you and grab your foot with your left hand. Gently pull your heel up toward your buttock, stretching the muscles in the front of your right leg for 20 seconds. Repeat the stretch with your left leg.



3. Groin Stretch
Squat down and put both hands on the floor in front of you. Stretch your left leg straight out behind you. Keep your right foot flat on the floor and lean forward with your chest into your right knee, then gradually shift weight back to your left leg, keeping it as straight as possible. Hold the stretch for 20 seconds. Repeat the stretch with your right leg behind you.



4. Hamstring Stretch
Lie down with your back flat on the floor and both knees bent. Your feet should be flat on the floor, about 6 inches apart. Bend your right knee up to your chest and grab your right thigh with both hands behind your knee. Gradually straighten your right leg, feeling gentle stretching in the back of your leg. Hold the stretch for 20 seconds. Repeat the stretch with your left leg.



This article provides a general overview on this topic and may not apply to everyone. To find out if this article applies to you and to get more information on this subject, talk to your family doctor.

source:http://www.familydoctor.org

Asthma in children usually has many causes, or triggers. These triggers may change as a child ages. A child�s reaction to a trigger may also change with treatment. Viral infections can increase the likelihood of an asthma attack. Common triggers of asthma include the following:

Respiratory infections: These are usually viral infections. In some patients, other infections with fungi, bacteria, or parasites might be responsible.

Allergens (see below for more information): An allergen is anything in a child�s environment that causes an allergic reaction. Allergens can be foods, pet dander, molds, fungi, roach allergens, or dust mites. Allergens can also be seasonal outdoor allergens (eg, mold spores, pollens, grass, trees).

Irritants: When an irritating substance is inhaled, it can cause an asthmatic response. Tobacco smoke, cold air, chemicals, perfumes, paint odors, hair sprays, and air pollutants are irritants that can cause inflammation in the lungs and result in asthma symptoms.

Weather changes: Asthma attacks can be related to changes in the weather or the quality of the air. Weather factors such as humidity and temperature can affect how many allergens and irritants are being carried in the air and inhaled by your child.

Exercise (see below for more information): Exercise can trigger asthma. Exactly how exercise triggers asthma is unclear, but it may have to do with heat and water loss and temperature changes as a child heats up during exercise and cools down after exercise.

Emotional factors: Some children can have asthma attacks that are caused or made worse by emotional upsets.

Gastroesophageal reflux (GER): GER is more commonly known as heartburn. GER is related to asthma because the presence of small amounts of stomach acid outside of the stomach (in the esophagus) can irritate the airways.

Inflammation of the upper airways (including the nasal passages and the sinuses): Inflammation in the upper airways, which can be caused by allergies, sinus infections, or lung (respiratory) infections, must be treated before asthmatic symptoms can be completely controlled.

Nocturnal asthma: Nighttime asthma is probably caused by multiple factors. Some factors may be related to how breathing changes during sleep, exposure to allergens during and before sleep, or body position during sleep.

Allergy-related asthma

Although an estimated 75-85% of people with asthma have some type of allergy, the allergy isn�t always the primary cause of asthma. Even if allergies are not your child's primary triggers for asthma (asthma may be triggered by colds, the flu, or exercise for example), allergies can still make symptoms worse.

Children inherit the tendency to have allergies from their parents. People with allergies make too much "allergic antibody," which is called immunoglobulin E (IgE). The IgE antibody recognizes small quantities of allergens and causes allergic reactions to these usually harmless particles. Allergic reactions occur when IgE antibody triggers certain cells (called mast cells) to release a substance called histamine. Histamine occurs in the body naturally, but it is released inappropriately and at too high an amount in people with allergies. The released histamine is what causes the sneezing, runny nose, and watery eyes associated with some allergies. In a child with asthma, histamine can also trigger asthma symptoms and flares.

An allergist can usually identify any allergies a child may have. Once identified, the best treatment is to avoid exposure to allergens whenever possible. When avoidance isn't possible, antihistamine medications may be prescribed to block the release of histamine in the body and stop allergy symptoms. Nasal steroids can be prescribed to block allergic inflammation in the nose. In some cases, an allergist can prescribe immunotherapy, which is a series of allergy shots that gradually make the body unresponsive to specific allergens.

Exercise-induced asthma

Children who have exercise-induced asthma develop asthma symptoms after vigorous activity, such as running, swimming, or biking. For some children, exercise is the only thing that triggers asthma; for other children, exercise as well as other factors trigger symptoms. Young children with exercise-induced asthma may have subtle symptoms such as coughing or undue breathlessness after physical activity during play. Not every type or intensity of exercise causes symptoms in children with exercise-induced asthma. With the right medicine, most children with exercise-induced asthma can play sports like any other child. In fact, over 10% of Olympic athletes have exercise-induced asthma they've learned to control.

If exercise is a child's only asthma trigger, the doctor may prescribe a medication that the child takes before exercising to prevent airways from tightening up. Of course, asthma flares can still occur. Parents (or older children) must carry the proper "rescue" medication (such as inhalers) to all games and activities, and the child's school nurse, coaches, scout leaders, and teachers must be informed of the child's asthma. Make sure the child will be able to take the medication at school as needed.

The Five Parts to an Asthma Treatment Plan

Step 1 - Identifying and controlling asthma triggers

Children with asthma have different sets of triggers. Triggers are the factors that irritate the airways and cause asthma symptoms. Triggers can change seasonally and as a child grows older. Some common triggers are allergens, viral infections, irritants, exercise, breathing cold air, and weather changes.

Identifying triggers and symptoms can take time. Keep a record of when symptoms occur and how long they last. Once patterns are discovered, some of the triggers can be avoided through environmental control measures, which are steps to reduce exposure to a child's allergy triggers. Talk with your doctor about starting with environmental control measures that will limit those allergens and irritants causing immediate problems for a child. Remember that allergies develop over time with continued exposure to allergens, so a child's asthma triggers may change over time.

Others who provide care for your child, such as babysitters, daycare providers, or teachers must be informed and knowledgeable regarding your child's asthma treatment plan. Many schools have initiated programs for their staff to be educated about asthma and recognize severe asthma symptoms.

The following are suggested environmental control measures for different allergens and irritants:

Indoor controls

1. To control dust mites:

Use only polyester-filled pillows and comforters (never feather or down). Use mite-proof covers (available at allergy supply stores) over pillows and mattresses. Keep covers clean by vacuuming or wiping them down once a week.

Wash your child's sheets and blankets once a week in very hot water (130 degrees Fahrenheit or higher) to kill dust mites.

Keep upholstered furniture, window mini-blinds, and carpeting out of a child's bedroom and playroom because they can collect dust and dust mites (especially carpets). Use washable throw rugs and curtains and wash them in hot water weekly. Vinyl window shades that can be wiped down can also be used.

Dust and vacuum weekly. If possible, use a vacuum specially designed to collect and trap dust mites (with a HEPA filter).

Reduce the number of dust-collecting houseplants, books, knickknacks, and nonwashable stuffed animals in your home.

Avoid humidifiers when possible because moist air promotes dust mite infestation.

2. To control pollens and molds:

Avoid humidifiers because humidity promotes mold growth. If you must use a humidifier, keep it very clean to prevent mold from growing in the machine.

Ventilate bathrooms, basements, and other damp places where mold can grow. Consider keeping a light on in closets and using a dehumidifier in basements to remove air moisture.

Use air conditioning because it removes excess air moisture, filters out pollens from the outside, and provides air circulation throughout your home. Filters should be changed once a month.

Avoid wallpaper and carpets in bathrooms because mold can grow under them.

Use bleach to kill mold in bathrooms.

Keep windows and doors shut during pollen season.

3. To control irritants:

Do not smoke (or allow others to smoke) at home, even when a child is not present.

Do not burn wood fires in fireplaces or wood stoves.

Avoid strong odors from paint, perfume, hair spray, disinfectants, chemical cleaners, air fresheners, and glues.

4. To control animal dander:

If your child is allergic to a pet, you may have to consider finding a new home for the animal or keeping the pet outside at all times.

It may (but does not always) help to wash the animal at least once a week to remove excess dander and collected pollens.

Never allow the pet into the allergic child's bedroom.

If you don't already own a pet and a child has asthma, don't acquire one. Even if a child isn't allergic to the animal now, he or she can become allergic with continued exposure.

Outdoor controls

When mold or pollen counts are high, give your child medications recommended by your doctor (usually an antihistamine) before going outdoors.

After playing outdoors, the child should bathe and change clothes.

Drive with the car windows shut and air conditioning on during mold and pollen seasons.

Don't let a child mow the grass or rake leaves.

In some cases, the doctor may recommend immunotherapy when control measures and medications are not effective. Speak with your child's doctor about these options.

Step 2 - Anticipating and preventing asthma flares

Patients with asthma have chronic inflammation of their airways. Inflamed airways are twitchy and tend to narrow (constrict) whenever they are exposed to any trigger (such as infection or an allergen). Some children with asthma may have increased inflammation in the lungs and airways everyday without knowing it. Their breathing may sound normal and wheeze-free when their airways are actually narrowing and becoming inflamed, making them prone to a flare. To better assess a child's breathing and determine risk for an asthma attack (or flare), breathing tests may be helpful. Breathing tests measure the volume and speed of air as it is exhaled from the lungs. Asthma specialists make several measurements with a spirometer, a computerized machine that takes detailed measurements of breathing ability.

At home, a peak flow meter (a hand-held tool that measures breathing ability) can be used to measure airflow. When peak flow readings drop, airway inflammation may be increasing. The peak flow meter can detect even subtle airway inflammation and obstruction, even when your child feels fine. In some cases, it can detect drops in peak flow readings 2-3 days before a flare occurs, providing plenty of time to treat and prevent it.

Another way to know when a flare is brewing is to look for early warning signs. These signs are little changes in a child that signal medication adjustments may be needed (as directed in a child's individual asthma management plan) to prevent a flare. Early warning signs may indicate a flare hours or even a day before the appearance of obvious flare symptoms (such as wheezing and coughing). Children can develop changes in appearance, mood, or breathing, or they may say they "feel funny" in some way. Early warning signs are not always definite proof that a flare is coming, but they are signals to plan ahead, just in case. It can take some time to learn to recognize these little changes, but over time, recognizing them becomes easier.

Parents with very young children who can't talk or use a peak flow meter often find early warning signs very helpful in predicting and preventing attacks. And early warning signs can be helpful for older children and even teenagers because they can learn to sense little changes in themselves. If they are old enough, they can adjust medication by themselves according to the asthma management plan, and if not, they can ask for help.

Step 3 - Taking medications as prescribed

Developing an effective medication plan to control a child's asthma can take a little time and trial and error. Different medications work more or less effectively for different kinds of asthma, and some medication combinations work well for some children but not for others.

There are two main categories of asthma medications: quick-relief medications (rescue medications) and long-term preventive medications (controller medications) . Asthma medications treat both symptoms and causes, so they effectively control asthma for nearly every child. Over-the-counter medications, home remedies, and herbal combinations are not substitutes for prescription asthma medication because they cannot reverse airway obstruction and they do not address the cause of many asthma flares. As a result, asthma is not controlled by these nonprescription medicines, and it may even become worse with their usage.

Step 4 - Controlling flares by following the doctor's written step-by-step plan

When you follow the first 3 steps of asthma control, your child will have fewer asthma symptoms and flares. Remember that any child with asthma can still have an occasional flare (asthma attack), particularly during the learning period (between diagnosis and control) or after exposure to a very strong or new trigger. With the proper patient education, having medications on hand, and keen observation, families can learn to control nearly every asthma flare by starting treatment early, which will mean less emergency room visits and fewer admissions, if any, to the hospital.

Your doctor should provide a written step-by-step plan outlining exactly what to do if a child has a flare. The plan is different for each child. Over time, families learn to recognize when to start treatment early and when to call the doctor for help.

Step 5 - Learning more about asthma, new medications, and treatments

Learning more about asthma and asthma treatment is the secret to successful asthma control. There are several organizations you can contact for information, videos, books, educational video games, and pamphlets (Visit this link)

Treatment of Asthma

The goals of asthma therapy are to prevent your child from having chronic and troublesome symptoms, to maintain your child�s lung function as close to normal as possible, to allow your child to maintain normal physical activity levels (including exercise), to prevent recurrent asthma attacks and to reduce the need for emergency department visits or hospitalizations, and to provide medicines to your child that give the best results with the fewest side effects.

Medicines that are available fall into two general categories. One category includes medications that are meant to control asthma in the long term and are used daily to prevent asthma attacks (controller medications). These can include inhaled corticosteroids, inhaled cromolyn or nedocromil, long-acting bronchodilators, theophylline, and leukotriene antagonists. The other category is medications that provide instant relief from symptoms (rescue medications).

These include short-acting bronchodilators and systemic corticosteroids. Inhaled ipratropium may be used in addition to inhaled bronchodilators following asthma attacks or when asthma worsens.

In general, doctors start with a high level of therapy following an asthma attack and then decrease treatment to the lowest possible level that still prevents asthma attacks and allows your child to have a normal life. Every child needs to follow a customized asthma management plan to control asthma symptoms. The severity of a child's asthma can both worsen and improve over time, so the type (category) of your child's asthma can change, which means different treatment can be required over time. Treatment should be reviewed every 1-6 months, and the choices for long- and short-term therapy are based on how severe the asthma is.

Talk to your doctor about the various medications available to treat asthma.

Follow this Legend: 1. Severity of Asthma||2. Long-Term Control ||3. Quick Relief

*1. Mild intermittent asthma
2. Usually none
3. Inhaled beta-2 agonist (short-acting bronchodilator)

If your child uses the short-acting inhaler more than 2 times per week, long-term control therapy may be necessary.

*1. Mild persistent asthma
2. Daily use of low-dose inhaled corticosteroids or nonsteroidal agents such as cromolyn and nedocromil (anti-inflammatory treatment), leukotriene antagonists, montelukast
3. Inhaled beta-2 agonist (short-acting bronchodilator)

If your child uses the short-acting inhaler everyday or starts using it more and more frequently, additional long-term therapy may be needed.

*1. Moderate persistent asthma
2. Daily use of medium-dose inhaled corticosteroids (anti-inflammatory treatment) or low- or medium-dose inhaled corticosteroids combined with a long-acting bronchodilator or leukotriene antagonist
3. Inhaled beta-2 agonist (short-acting bronchodilator)

If your child uses the short-acting inhaler everyday or starts using it with increasing frequency, additional long-term therapy may be needed.

*1. Severe persistent asthma
2. Daily use of high-dose inhaled corticosteroids (anti-inflammatory treatment), long-acting bronchodilator, leukotriene antagonist, theophylline, omalizumab (for patients with moderate-to-severe asthma brought on by seasonal allergens despite inhaled corticosteroids)
3. Inhaled beta-2 agonist (short-acting bronchodilator)

If your child uses the short-acting inhaler everyday or starts using it with increasing frequency, additional long-term therapy may be needed.

*1. Acute severe asthmatic episode (status asthmaticus)
2. This is severe asthma that often requires admission to the emergency department or hospital.
3. Repeated doses of inhaled beta-2 agonist (short-acting bronchodilator)

**Seek medical help**

Acute severe asthmatic episode (status asthmaticus) often requires medical attention. It is treated by providing oxygen or even mechanical ventilation in severe cases. Repeat or continuous doses from an inhaler (beta-2 agonist) reverse airway obstruction. If the asthma isn�t corrected using the inhaled bronchodilator, injectable epinephrine and/or systemic corticosteroids are given to reduce inflammation.

Fortunately, for most children, asthma can be well controlled. For many families, the learning process is the hardest part of controlling asthma. A child might have flares (asthma attacks) while learning to control asthma, but don't be surprised or discouraged. Asthma control can take a little time and energy to master, but it's worth the effort!

How long it takes to get asthma under control depends on the child's age, the severity of symptoms, how frequently flares occur, and how willing and able the family is to follow a doctor's prescribed treatment plan. Every child with asthma needs a doctor-prescribed individualized asthma management plan to control symptoms and flares. This plan usually has 5 parts.

Symptoms of Asthma

*Wheezing

Wheezing is when the air flowing into the lungs makes a high-pitched whistling sound.

Mild wheezing occurs only at the end of a breath when the child is breathing out (expiration or exhalation). More severe wheezing is heard during the whole exhaled breath. Children with even more severe asthma can also have wheezing while they breathe in (inspiration or inhalation). However, during a most extreme asthma attack, wheezing may be absent because almost no air is passing through the airways.

Asthma can occur without wheezing, so wheezing is not necessary for the diagnosis of asthma. Also, wheezing can be associated with other lung disorders, such as cystic fibrosis.

In asthma related to exercise (exercise-induced asthma) or asthma that occurs at night (nocturnal asthma), wheezing may be present only after exercise or during the night.

*Coughing

Cough may be the only symptom of asthma, especially in cases of exercise-induced or nocturnal asthma. Cough due to nocturnal asthma (night time asthma) usually occurs during early hours of morning, such as 1 am to 4 am. Usually, the child doesn�t cough anything up so there is no phlegm or mucus. Also, coughing may occur with wheezing.

*Chest tightness

The child may feel like the chest is tight or won�t expand when breathing in, or there may be pain in the chest with or without other symptoms of asthma, especially in exercise-induced or nocturnal asthma.

*Other symptoms

Infants or young children may have a history of coughs or lung infections (bronchitis) or pneumonia. Children with asthma may get coughs every time they get a cold. Most children with chronic or recurrent bronchitis have asthma.

**Symptoms can be different depending on whether the asthma episode is mild, moderate, or severe.**

Symptoms during a mild episode: Children may be out of breath after a physical activity, such as walking. They can talk in sentences and lie down, and they may be restless. The feeding may be with interruption, therefore, the infant takes longer to finish the feed.

Symptoms during a moderately severe episode: Children are out of breath while talking. Infants have a softer shorter cry, and feeding is difficult. There is feeding with interruption and child may not be able to finish the usual quantity of the feed.

Symptoms during a severe episode: Children are out of breath while resting, they sit upright, they talk in words (not sentences), and they are usually restless. Infants are not interested in feeding and are restless and out of breath. Infant may try to start feeding but can not sustain feeding due to breathlessness.

Symptoms indicating that breathing will stop: In addition to the symptoms already described, the child is sleepy and confused. However, adolescents may not have these symptoms until they actually stop breathing. The infant may not be interested in feeding.

In most children, asthma develops before the age of 5 years, and in more than half, asthma develops before the age of 3 years.

Tests Used to Diagnose Asthma

Pulmonary function tests (PFTs) are used to test lung performance, but in children younger than 5 years, the results are typically not reliable.

• An asthma specialist, such as a pulmonologist or allergist, can perform breathing tests using a spirometer, a machine that measures the amount of air that flows in and out of the lungs. It can detect blockage if the airflow is lower than normal, and it can also detect if the airway obstruction is involving only small airways or larger airways too. The doctor may take a spirometer reading, give the child an inhaled medication that opens the airways (bronchodilator therapy), and then take another reading to see if breathing improves with medication. If medication reverses airway obstruction (blockage), as indicated by improved airflow, then there's a strong possibility that the child has asthma. A peak flow meter is a simple device used to measure the peak flow of air coming out of the lungs when a child is asked to blow air into it. The peak flow meter readings are different than spirometer readings. However, a child can have a normal peak airflow and still have airway obstruction that is not detected with spirometry. The peak flow can have a normal value while the values for other parameters, such as forced expiratory volume in 1 second (FEV1) or forced expiratory flow during mid-portion of forced vital capacity (FEF25-75), are reduced suggesting airway obstruction. Thus, spirometry is more informative compared to only peak flow meter readings.
• Another test is called plethysmography. This test measures lung capacity and lung volumes (the amount of air the lung can hold). Patients with chronic persistent asthma may have lungs that are over-inflated; over-inflation is diagnosed when a patient has increased lung capacity detected by this test.
• Other tests called bronchial provocation tests are performed only in specialized laboratories by specially trained personnel. These tests involve exposing patients to irritating substances and measuring the effect on lung function.
• Patients with a history of exercise-induced symptoms (eg, cough, wheeze, chest tightness, pain) can undergo an exercise challenge test. This test is usually done in children older than 6 years. The baseline (or usual) lung function for the child is measured (using spirometry) while the child is sitting still. Then the child exercises, usually by riding a stationary bicycle or walking fast on a treadmill. When the child�s heart is beating faster from the exercise, the lung function is measured again. Measurements are taken immediately after the exercise and at 3, 5, 10, 15, and 20 minutes after the first measurement. This test detects decreased lung function caused by exercise.
• Your doctor may take a chest x-ray (radiograph) if the asthma isn�t helped by the usual treatments.
• Allergy testing can be used to identify factors your child is allergic to because these factors might contribute to asthma. Once identified, environmental factors (eg, dust mites, cockroaches, molds, animal dander) and outdoor factors (eg, pollen, grass, trees, molds) may be controlled or avoided to reduce asthma symptoms.
• Ask your doctor for more information on these and other tests.