London Lifestyle Doctor

Exciting adventure awaits!! Departing Lyon for a week of tennis, hiking, white water rafting and other adrenaline filled mountain activities!

Kolejny wieczór, kolejna gra!! ❤️TENIS 🎾

̇ycia

Gotowa na wieczorna praktyke tenisa!! 2 godzinki cardio+siła i będę baaaardzo szczęśliwa!! 🎾
́wiczenia

Dziś kontynuacja poprzedniego postu na temat tego, ile ćwiczyć, żeby mieć korzyści zdrowotne. Co to znaczy ćwiczyć kardio ze średnią lub wysoką intensywnością? Kiedy idziemy na zajęcia HIIT (High Intensity Interval Training), to znaczy że z jaką intensywnością będziemy ćwiczyć? Jak ocenić intensywność ćwiczeń? Ciągle pytają mnie o to pacjenci, którym zalecam ćwiczenia fizyczne. Większość z nich nie ma pojęcia jak ocenić intensywność ćwiczeń!

✅ Intensywność ćwiczeń zależy od tego, jak bardzo przyspiesza nasze serce podczas wykonywania tych ćwiczeń. Na przykład, jeśli siedzę przed komputerem (czyli jestem w spoczynku), to moje serce bije około 60 razy na minutę. Ale jak biegnę, to ta prędkość wzrasta na przykład do 150/minutę.

✅ W pierwszej kolejności musimy ustalić jak maksymalnie szybko może bić nasze serce podczas aktywności fizycznej - czyli obliczyć tzw. maksymalne tętno (HR Max) To jest zależne od wieku, i łatwo się oblicza, wg. wzoru*:
HR Max = 220 - wiek.
Czyli na przykład jeśli masz 40 lat, to twoje HR Max wynosi:
220-40=180 uderzeń na minutę.

✅ Wysoka intensywność ćwiczeń to taka, kiedy serce bije w przedziale 77%-93% wartości HR Max. Czyli dla powyższego przykładu: u osoby w wieku 40 lat, HR Max to 180 uderzeń na minutę. 77% tej wartości to: 138/min. a 93% HR Max to 167/min.

✅ Średnia intensywność ćwiczeń to taka, kiedy serce bije w przedziale 64% - 76% HR Max.

✅ To jak szybko bije nasze serce podczas ćwiczeń, można łatwo zmierzyć za pomocą smart watch-a. A jeśli go nie masz, to można to dość łatwo ocenić w przybliżeniu, stosując "TEST MOWY":

‼Średnia intensywność: możesz mówić, ale nie śpiewać (bo musisz brać oddechy).
‼Wysoka intensywność: jesteś w stanie powiedzieć tylko kilka słów pomiędzy kolejnymi oddechami.

*Jest to obliczenie wg. wytycznych CDC - Centers for Disease Control and Prevention (link poniżej). Wszystkie zalecenia w tym poście odnoszą się do dorosłych osób bez przeciwskazań. Po specyficzne zalecenia dla starszych, w ciąży, dzieci, z chorobami przewlekłymi -sprawdź specyficzne wytyczne na stronie CDC.
https://www.cdc.gov/physicalactivity/basics/measuring/heartrate.htm

Ciągle radzę moim pacjentom, żeby ćwiczyli, dla zdrowia! Ale praktycznie nikt z nich nie wie ile tych ćwiczeń ma wykonywać....dlatego daję im bardzo specyficzne porady. A Ty wiesz jakie są zalecenia? No i w jakim celu powinien każdy ćwiczyć ? Po pierwsze, oczywiście dla zdrowia. Regularne ćwiczenia rzecz jasna przyczynią się także do wymodelowania sylwetki.

Na podstawie badań ustalono ile trzeba ćwiczyć, żeby mieć korzyści zdrowotne, głównie jeśli chodzi o zdrowie serca i naczyń krwionośnych. A zalecenia te, dla dorosłych (bez przeciwskazań*) w wieku 18-64 lat, wg. WHO wyglądaja następująco:

💪 Tygodniowo: co najmniej 150-300 minut aktywności aerobowej (czyli kardio) o średniej intensywności, LUB

💪 Tygodniowo: co najmniej 75-150 minut aktywności kardio o wysokiej intensywności.

💪 Dodatkowo: ćwiczenia wzmacniające mięśnie (głównie duże grupy mięśniowe) min. 2 razy w tygodniu.

Ale pytanie zasadnicze jest takie: co to znaczy średnia lub wysoka intensywność ćwiczeń? Jak ją zmierzyć? Wiesz? Napisz w komentarzu!!
Napiszę o tym w kolejnym poście, następnym razem 😁
Póki co, uciekam na siłownię! 🏋️‍♀️🏋️‍♀️🏋️‍♀️

*Istnieją osobne, specyficzne zalecenia dla osób starszych, z chorobami przewlekłymi, w ciąży, dzieci. Po szczegóły - zobacz stronę WHO ( link w komentarzu).

Another skiing photo from my collection! Remembering good times!

Health through water 💦 💦 💦
SPA = Sanus Per Aquam
Swimming is a great workout. I particularly enjoy it after skiing as it relaxes me.

I am still in Tignes, sharing good times with friends, skiing! From the wellbeing perspective, it’s super important to be surrounded by friends and to make meaningful connections with others. And if this is combined with exercise, that’s perfect!

Skiing! Movement is medicine!

Which diet is the healthiest? According to the US News & World Report 2023 it is the Mediterrenean Diet. I personally eat a plant based diet on most days, but sometimes I just crave that yummy fish! Today it’s a salmon steak served with yummy veggies!

I love going to the gym!
💪💪💪Strenght training is my particularly favourite, as it builds my form for performing the sports I love, such as skiing, playing tennis and hiking.
Squats are particularly amazing to build these skiing legs, so I am not shy of squatting! And doing squats with a light bar (I always do 10 kg), elevates this simple exercise to a different level. 🏋️‍♀️🏋️‍♀️🏋️‍♀️
⛷ I am hitting the slopes next week - are you ready for your skiing season? ⛷
✅ According to the Physical Activity guidelines for Americans, strenght exercises should be performed 2-3 days per week, allowing 48 hours for muscle recovery between training days.
✅ Cardio can be done every day, the minum recommended amount is 150 mins of moderate intensity activity per week.
‼So what are you waiting for?? Hit that gym‼

💪 ✌️

A great way to relax the mind: visit beautiful Krakow and admire the view! ❤️

Dark, winter days are coming. Supplemenation of vitamin D during the winter months is recommended by the guidelines in the UK. Check out NHS guidance as to the dose YOU should be taking. Link in the comment.

☕️ Coffee: To drink or not to drink? ☕️

There has been a lot of debate whether is good or bad for . A great review article has been published in the New England Journal of Medicine back in 2020. It concludes the following:
☕️ There is a lot of scientific evidence showing that caffeinated coffee does not increase the risk of cardiovascular diseases and cancers
☕️ Drinking 3 – 5 standard cups of coffee per day is associated with a reduced risk of several chronic diseases.
☕️ High caffeine intake can have various adverse effects, therefore limits of 400mg of caffeine per day for adults who are not pregnant or lactating have been recommended, and in some people with higher sensitivity to caffeine, these limits may be lower
☕️ Current evidence does not warrant recommending caffeine or coffee intake for disease prevention
☕️ Moderate consumption of coffee or tea can be part of a healthy lifestyle.
The photo below shows my yummy espresso which I was enjoying on a beautiful Alpine meadow after a long hike in June 2022, admiring views of Argentière, France.

Publication reference: van Dam RM, Hu FB, Willett WC. Coffee, Caffeine, and Health. N Engl J Med. 2020 Jul 23;383(4):369-378. doi: 10.1056/NEJMra1816604. PMID: 32706535

❤ Yesterday was World Menopause Day ❤
Lots and lots of patients suffer immensely due to menopause-related symptoms! Unfortunately lots of patients do not know enough about menopause and are often afraid to approach their GPs. Many worry they would not be taken seriously, or they think that menopause is simply part of life and therefore suffering is expected. Nobody should be suffering if help is possible!

During my work as a GP I have been consulting patients with problems related to menopause on a daily basis. In fact on a regular work day I would see at least a few such patients. The most typical symptoms reported by these patients were: tiredness, low libido, feeling low and overwhelmed, hot flashes and night sweats, brain fog and memory problems, weight gain, vaginal dryness, anxiety, sleep disturbance – not necessarily in this order of frequency! Patients would often cry during the consultation and be very, very bothered by their symptoms. Many told me how the menopause made their lives awful.

In fact it is highly personal for different patients which symptoms they experience most frequently and which ones are the most bothersome for them. Many, many patients experienced decreased quality of life as a consequence of these symptoms, and lots have suffered deeply. It was of utmost importance for me as a GP to understand and fully support my patients, to the best of my knowledge and ability.

Of course we as GPs need to approach each patient individually, in the holistic way, taking into account the psychosocial context in which they are experiencing these symptoms and we need to understand how these symptoms are affecting their day to day functioning. There is so much to say about menopause from the GP perspective! I have included below a summary of key, in my opinion, facts:

❤ Menopause is the final menstrual period in life and it is diagnosed once a patient has stopped having their periods for at least 1 year, at which point a patient enters postmenopause. Sometimes this may be difficult to tell, for example if a patient had her uterus removed or if she has been using a method of contraception which stopped her from having periods (for example an intra-uterine system – a hormone-releasing coil).

❤ Perimenopause is when a patient is still having periods but these are now irregular and a patient is experiencing typical menopausal symptoms (which I describe above).

❤ In patients wo are either postmenopausal or perimenopausal and aged over 45 – no testing of hormone levels is indicated by the guidelines in the UK, as the diagnosis is clinical based on the symptoms.

❤ Menopausal symptoms are caused by declining levels of oestrogen due to aging-related loss of the function of ovaries.

❤ However, very importantly, such symptoms can be also due to other than menopause causes, some of them being serious. This is why, it is absolutely key to always discuss these symptoms with your GP in the first place. A GP can perform other tests as considered necessary, to exclude other cause of these symptoms, if there is any doubt. Remember: every patient is unique and an individual approach to manage menopause is needed. One advice does NOT fit all. Therefore be cautious about what you read online or what you hear from friends - and always, always talk to your GP to have your particular case individually assessed.

❤ If other causes for symptoms are excluded and if there are no contraindications - then we GPs are very happy to treat menopausal symptoms with Hormone Replacement Therapy (should a patient wish for this), and of course also advise on lifestyle measures, which can make a difference. There are also non-hormonal drug treatments available for those who do not wish to take HRT or have contraindications – please again discuss with your GP. Regarding complimentary therapies (herbal preparations): There is some evidence of efficacy for some of them but the quality, purity, constituents, and safety of these products may be unknown, therefore we do not recommend them.

❤ Because the menopausal symptoms are caused by declining levels of oestrogen – the goal of HRT is to replenish these levels of oestrogen by supplementing oestrogen.

❤ Because taking oestrogen can cause growth of the lining of the uterus which can be a risk factor for a cancer, progesterone is given to protect the uterine lining and stop it from growing. For this reason in patients without uterus - oestrogen-only HRT is indicated, as long as there are no contra-indications.

I hope this summarised some facts about menopuase and its treatment nicely for you. It is a vast topic and lots more could be written! Ultimately the key message is – every patient is unique and the medical approach to that patient also needs to be unique. If you are experiencing menopausal symptoms, please discuss with your GP in the first instance. I will reiterate – we, GPs, are very happy to consult patients about menopause and prescribe HRT if you have no contra-indications.

Disclaimer: The above text is meant for information and education purposes only and does not constitute an individual medical advice.

Reference: NICE Clinical Knowledge Summary "Menopause", last revised in March 2022