Active Health Podcast Ep 4: Exercise as Prevention: Building Health Resilience

00:02:19 Speaker 1

Hello, everyone, good afternoon. Welcome to the last episode of our podcast. Once again, I'm your host, my name is RJ, I'm an Active Health coach from Sports Singapore. There's a poll on screen right now to ask if you are public service officer. Please help me to answer that, and once you are done, just close the box dialogue box, once you are done, right. Okay, so today very excited to have sport and exercise medicine physician Doctor Mandy with me today to discuss the positive effects of exercise.

00:02:48 Speaker 1

And how we can start and to get higher adherence for exercise. Thank you for joining us, doctor Mandy. Apart from being a sport and exercise medicine specialist, could you also share with us your role in CGH?

00:03:02 Speaker 2

Hi, Rui Jie, thank you for inviting me to this podcast, it's indeed a pleasure to be here. I am a sports physician from Changi General Hospital. I teach at the Exercise is Medicine programme in Singapore, and I currently act as a director of Sport and Exercise Medicine in Changi General Hospital.

00:03:24 Speaker 1

Thank you, doctor Mandy, for the brief introduction. A disclaimer, the information discussed today will be for educational and information purpose. For any specific health advice relating to your condition, please consult a qualified healthcare professional. Okay, with that out of the way, doctor Mandy, could you share with us what exercise is medicine, and what is exercise as medicine?

00:03:47 Speaker 2

Okay, so exercise is medicine, short form EIM. This is part of a global initiative by American College of Sports Medicine, where we have a simple but powerful mission to spread physical activity, and it says that you know, physical activity should be not be an option for standard part of care, but rather an essential component of every patient who comes through for their chronic medical, chronic medical conditions and diseases. So yup, it's really using exercise as part of a treatment for our patients.

00:04:27 Speaker 1

I totally agree with you, so it's act like a preventive measurement, right, so exercise act as a preventive measurement, and also I myself have attended the EIM course, and I find it very helpful when I'm helping someone who is medically at risk. You know, as I start to learn more about the benefits and the mechanisms that can contribute positively, you know, to managing our chronic conditions, I was sold by the idea. You know, on the flip side, there are people that know exercise is beneficial, good for them. However, they are unsure about how to use it strategically as a form of preventive measure, so I believe that's what we are here to discuss today, right?

00:05:05 Speaker 2

Yeah, so Rui Jie it was so nice to see you at our course and as as you have known, you've really made a important point, and that is because when I see patients in my clinic. You know it's easy to tell them “Hey, you should be exercising” and often patients know that they should exercise, but they don't know how, so often you know what type of exercise is good for them? How should they start?

00:05:33 Speaker 2

How often they should do it? For how many times a week, and how much volume to make impact on their chronic health conditions, and if you think about it, exercise prescription should be seen quite similarly as a drug prescription. When I prescribe a medication or drug to my patient, I would tell them, “Okay, this is the medication you should take”, this is the dose, how many times a day or for how long? And you know when to stop, what complications to look out for. So I believe that exercise prescription can be given with more structure, more clarity, so that it can create more impact, good impact to our patients.

00:06:20 Speaker 1

Yeah, totally agree with you, right, because as a active health coach, people that walks into the lab, said the same thing. How can I start exercising? Where should I start? How much is enough? How much is too much? You know, so I do get the same questions from public as well, but let's slow down. Let's start with the basics first, let's start with science. So I mentioned earlier that I was amazed by the how, what exercise can do to help manage or prevent chronic conditions. Now you're the expert here, so could you share with us what is happening in our bodies that creates this positive effects?

00:06:54 Speaker 2

Yeah, so if you think about it exercise, when we exercise, it's almost like switching on a healing switch in our body, so it gets turned on. There's so much positive effects, our immune system is boost. We see a reduction in inflammation, and if you've gone through a bout of exercise, which I hope you have, some of you have go ne through, and and you'll feel like there's a feel good component right after exercise. Yeah, and that's because we have the happy hormones or the endorphins being raised as we go through a bout of exercise, and in addition, when we exercise, our heart starts to pump more efficiently, and we improve blood circulation.

00:07:41 Speaker 2

So all of this adds up, and I would say that exercise is not just about looking fit on the outside, but also having a very balanced, healthy inside.

00:07:54 Speaker 1

Yeah, I agree with you, after a run, I do really feel good, so I guess that's the happy hormones acting up. Yeah, but I do have a follow up question. Right. You mentioned inflammation, so probably could you expand on that?

00:08:04 Speaker 2

Yeah, so there are chemicals and cytokines in our body that that get suppressed during exercise, so maybe to keep it short and not going into too scientific details on what cytokines or chemicals they are, but essentially when we exercise it dampens down any pro inflammatory chemicals, and as a result this leads on to decrease inflammation in the body.

00:08:30 Speaker 1

Oh, that's nice to hear. So inflammation could be like things like your cancer markers as well, right?

00:08:39 Speaker 2

Your cancer markers, inflammatory markers. It's It's amazing, right?

00:08:41 Speaker 1

Okay, let's move on to this self-reported National Health Population survey back in 2024. It was found that actually one in eleven individuals have diabetes. One in three have elevated blood pressure as well as cholesterol. There are some ways physical activity can help one to reduce the likelihood of these conditions.

00:09:02 Speaker 2

Yeah, so if we look at these numbers, they are pretty striking, and the thing is, if we do not do anything, these numbers are set to increase. If we look at the WHO, the World Health Organisation, and you know they look at the global world as a whole. There is an impact to cost, there is an impact on healthcare if we do not manage these chronic diseases.

00:09:27 Speaker 2

But you know the good thing is, physical activity can play a huge role in managing many of the chronic diseases, and including some of the ones that we're going to talk today. You know the high blood pressure, diabetes and high cholesterol.

00:09:44 Speaker 1

Yup, so I have a follow up question on hypertension. Right, so if let's say somebody who is currently taking their blood pressure medication prescribed by a doctor, could a healthier lifestyle help them to reduce or eventually remove this medication that they are taking?

00:09:59 Speaker 2

Okay, so let's talk about what happens when to the body when we exercise, and how does we? How can we take exercise as a treatment for high blood pressure? So when we exercise, there's increased blood flow to our blood vessels, so it helps to increase this um and it releases this chemical called nitric oxide.

00:10:21 Speaker 2

Nitric oxide is a vasodilator, so it helps to relax the blood vessels, and therefore lower the blood pressure. Now, when we look at some studies, we see that with moderate intensity of exercise about thirty to sixty minutes each time, three times a week.

00:10:42 Speaker 2

This could actually bring a drop in systolic blood pressure of about eight to ten points, and if we translate it to how much blood pressure medication can do for our body, that's almost quite equivalent, so the exercise could actually be as effective as a single dose of blood pressure medication. To your second question, you mentioned about whether someone could discontinue their medication, Yes, after starting one.

00:11:12 Speaker 2

Well, there is a possibility of cutting down the medication, but one would have to adhere to good lifestyle modification, and this would mean weight loss, managing your diet, exercising regularly, limiting your alcohol intake, decreasing salt intake, and while you are thinking of doing so, I would urge you to keep a good record of your blood pressure readings at home.

00:11:41 Speaker 2

And also discuss this intention with your general practitioner, because while it is possible to do so, I would say many are unable to maintain a good blood pressure without medication upon starting one. Another thing to note is that as we age, it's a natural process that our vessels, our blood vessels starts to stiffen, and it's a. It's a process that we all go through, so inevitably the blood pressure would increase as we grow older, so we can't defy age.

00:12:15 Speaker 1

Definitely, unfortunately, so do do do do, take note of your doctor's prescription, so if you have to take them, please do take them right. Absolutely ya. So let's move on to the other two conditions, so like high cholesterol and diabetes, maybe we can start with our cholesterol first, yup.

00:12:30 Speaker 2

Okay, so for those with high cholesterol, how exercise helps. Is that you know, if you go to a doctor, you will do a profile, they tell you whether your bad cholesterol is good, your good cholesterol is good, right, generally. And exercise helps to clear away the bad cholesterol or the LDL, and then it helps to boost the HDL, which is the good cholesterol, and we see in studies that regular exercise helped to improve the lipid profile or blood cholesterol profile by about 5 to 10 percent.

00:13:02 Speaker 1

Okay, so diabetes, how about diabetes?

00:13:05 Speaker 2

Yeah, so diabetes, that's a really good question, so, maybe if I put it this way, if you think about it, if you are someone who is sedentary, okay, when you take sugar, sugar remains in the bloodstream, okay, and it does not get absorbed as well into the muscles, but with exercise, our muscles actually creates more doors, okay, and they are the glute, the glucose transporters, or we call them the glute four. Yup. So when you take in sugar and it flows through the bloodstream, and with exercise we have more doors open. Okay, sugar from the bloodstream can then be taken into the muscles more efficiently.

00:13:51 Speaker 1

Uh, so that's how it regulates the the blood sugar.

00:13:54 Speaker 2

Yes, and then we see you know a decrease in your fasting sugar. We see a decrease in your, you know, two hours post meal sugars. So yeah, exercise helps to improve our blood sugar levels.

00:14:08 Speaker 1

Okay, so now, thanks for sharing, you know the mechanisms of exercise for these three conditions. So there's a lot to to take note, but don't worry, we will still go on slowly, and as you hear more and more, you will be able to understand the the in depth explanation of exercise, how it can help you to manage. Now, let's move on to how exercise can be used as a preventive approach, so maybe we could start with hypertension first.

00:14:34 Speaker 1

You know, people are experiencing high blood pressure younger these days due to our modern lifestyle, our higher stresses due to work and less physical activity, and commonly hypertension is also known as a silent killer. So what are the longer-term implications of high blood pressure, and how does physical activity helps to prevent it?

00:14:55 Speaker 2

Yeah, so Rui Jie, you know, like it's it's, it's a bit worrisome, because now in the clinic I'm starting to see younger and younger patients in their twenties and thirties, seeking help for high blood pressure. And it's not uncommon, because as you mentioned, sedentarism lifestyle and lack of exercise, you know, this all add up. Now, the tricky part about high blood pressure is often people don't know about it.

00:15:25 Speaker 2

Yes, right, and it's only if you go to a GP, you get it checked, or you pick up a blood pressure machine from a family member at home, and you realise, oh, dear, you know, is it a bit higher than the normal range.

00:15:38 Speaker 2

But so the thing about not managing high blood pressure is that it quietly, but slowly damages and weakens the blood vessels and increases our cardiovascular risk so much so that you know there's a increased risk in stroke, heart attack when blood pressure is not managed properly when we talk about how exercise helps, again when we exercise you know, there's increased blood flow through this blood vessels, so it allows more compliance in this blood vessels. They are able to stretch a bit better, and then with the chemical release, such as the nitric oxide, it relaxes the blood vessels, and so that we see a drop in blood blood, sorry, blood pressure levels. Yes, yes, so yeah, that's about it, really

00:16:35 Speaker 1

It's a really, safe and a natural remedy right? you say. Absolutely, yeah, yeah. So let's turn our focus to pre-diabetes instead of diabetes. So because we're talking about preventative measurement, right, so exercise can be used again as a strategy for someone who is pre-diabetic, so after they get their initial diagnosis from the doctor, are there some specific guides when embarking on their healthier lifestyle changes?

00:17:02 Speaker 2

Okay, so the great thing about pre-diabetes is, it is a reversible stage. Yes, so prevention better than cure, right, and you want to catch pre-diabetes before it progresses to a full-blown diabetes stage.

00:17:19 Speaker 2

Now in pre diabetes phase, we look at exercise again, being opening that doors and increasing that uptake of sugar, maintaining a a good steady state in your bloodstream, and you know, studies have shown that in pre diabetes phase, especially okay, exercise is more effective than a diabetic medication, which commonly known as metformin, so when they did a head to head study, we found that the sugar improvement was actually increased or more in the group of patients who went through a consistent exercise as compared to those who took metformin.

00:18:05 Speaker 2

Ya, so in the pre-diabetes phase, yes, exercise would be your main lifestyle modification. But you know it's a different story, once you're diagnosed with diabetes, you may require a little bit more attention, you know, and medications.

00:18:19 Speaker 1

Okay, so I think it's a multiprong approach, so I think you have to eat well as well, you have to have a good sleep as well. So for example, poor sleep, you know, can lead to like increase of hunger hormones, and they're making us feel hungry faster, that's where we might have all the sugary stuff as like a craving, so I believe activity as well, like we want to aim for at least 150 minutes of moderate intensity in a week, and I think now we can talk about the prescription, which is FITT, you know, the frequency, the intensity, the time and the type. So for someone who may be having chronic conditions, the recommended frequency will be three to five times in a week, and the intensity will be moderate. So as we are using the talk test to explain is more, I can talk while I'm performing the activity.

00:19:05 Speaker 1

But cannot sing my favourite song. Yes, that's right, right, and of course the the time will be 30 minutes per session, and the type of physical activity will be your favourite choice of aerobic activity, in this case, yeah. Okay, so I think a lot of people have been telling me, my doctor says that I have high cholesterol and that is normal. Is that really normal? And what are some complications and how exercise can help it?

00:19:32 Speaker 2

Okay, well, so for high cholesterol, well, yes, you know, we looked at the National Survey. One in three adults in Singapore have high cholesterol. And well, while it is common, it is not normal, and we have to start taking some actions.

00:19:52 Speaker 2

Yeah, so in high cholesterol, usually there's plaque formation and build-up of plaque in the blood vessels, which then narrow the blood vessels and reduces blood flow to the brain, to the heart, you know, thus increasing our cardiovascular risk. With exercise, it helps to clear all these bad plaque, improve the bad cholesterol, and also in, you know, improve the, I mean, lower the blood cholesterol and then improve the good cholesterol. So all in all this helps you know, with a a good healthy profile of cholesterol in our body.

00:20:27 Speaker 1

Okay, so for those who have been telling me that is normal, definitely is not normal now that we have learnt it. And of course we need to take action, so we, let's move on to discussing how someone can start exercising with chronic conditions, so we learn that movement definitely can help us to manage or prevent chronic conditions. And for someone who has been sedentary for a while now, how can they start moving?

00:20:51 Speaker 2

Okay, well, for someone who is sedentary, I think the most important thing to do is to start. Okay, so for those of you who are here today, who wants to embark on exercise, exercise program, but haven't, maybe could I urge you after this talk once you've had your lunch to just go for a ten minutes, walk about around your house or your environment or anywhere that's convenient, and you know the keyword is start, and something is better than nothing.

00:21:21 Speaker 2

Yeah, I always tell my patients also to start low, go slow, which means you don't have to do a high intensity about right at the four at the start, right, you can start low, go with a low intensity, something you enjoy, and then slowly build up once you adapt to this lifestyle, and the key here is really consistency.

00:21:45 Speaker 2

Yes, so we want to build a habit around exercise, and this means like you know, as much as you know, we would brush our teeth everyday, right, it becomes such a routine. How can you build an exercise program around your regular schedule and routine?

00:22:01 Speaker 2

So if you think about it, this may be putting in, you know, before you know, before you, before you start work in the day, or perhaps after dinner to go for a walk, or maybe after you drop off your kids, is there like a thirty minutes where you could embark on some exercise? And at the end of the day, if you don't feel well because you are starting exercise for the first time, then seek medical attention, or you know, talk to somebody who knows how to do it. To deal with your chronic disease, who knows a little bit more about exercise, who can help you embark on this journey.

00:22:37 Speaker 1

I think I agree with you. Thanks for sharing some practical tips on how someone can get little movements in. You know, like just thirty minutes, just ten minutes. I think it makes a whole lot of difference as well. I think I can relate, because when someone comes into our lab for the first time and they are very reluctant to sign up for exercise class, but once they sign up and I see them here exercising, oh, it makes such a difference, they come back to me. They say, you know, thank you for persuading me to actually sign up for exercise class, now I feel better, I can walk better.

00:23:04 Speaker 1

My knees are not hurting anymore, so I totally agree that we should just start something first, not through exercise class, but just ten minutes of walk to see where you you like, right.

00:23:20 Speaker 2

Yeah, I can assure you, once you start, you'll feel much more confident, more strength, more energy. So ya, the key is to start.

00:23:23 Speaker 1

Okay, I got two questions relating to chronic condition. The first one is, let's say I'm diagnosed with high blood pressure currently, what are some exercise considerations that I should look out for? And secondly, if I have multiple chronic conditions, will this consideration be any different?

00:23:42 Speaker 2

Okay, so to answer your first question about special considerations for people with high blood pressure and starting on exercise, what we're trying to do is really to avoid spikes in the blood pressure when you embark on the exercise, so I would recommend something that is cardio based. Something more on a steady state, so this could be brisk walking, cycling, swimming, something that you enjoy.

00:24:07 Speaker 2

And when, if you are doing any weight training, that's where we sometimes get a a spike in our blood pressure, so I would like you to focus a little bit on the breathing, so to coordinate the breathing when you push against a heavy load to avoid holding your breath, but to coordinate the breathing out as you push against a heavy load.

00:24:30 Speaker 2

Okay, and you know the last thing would be to really emphasise a little bit more on warm-ups and cool downs, so we don't want that sudden spike and sudden drop in blood pressure. Again, you want to slowly adjust your body to the exercise and then slowly adjust the body back to baseline.

00:24:49 Speaker 1

Yup, I think the the point where you mentioned breathing right, I think a lot of people struggle with that because they don't know when to breathe in and when to breathe out. So usually I'll just tell them when you are lowering something, you know you breathe in. And as you are pushing or as you are pressing on something, you want to breathe out. So I think that that helps a lot in people that don't quite get that that pattern at the start.

00:25:09 Speaker 1

And of course, when you mentioned about warm up and cool downs, right, I think warm up is definitely a must must to do before you start engaging in a moderate to vigorous activity, especially start at 50 percent of your intended intensity. For example, if you are going for a walk, I think you can start with a light brisk walk first, right, bring up your core temperature so that to prepare for your run.

00:25:30 Speaker 1

And of course, when we cool down, we just don't want to stop abruptly as well, similarly to when we start, and of course, add in some mobility work at the end, some static stretches as well. Alright, okay, so for the second question, right, so you've got multiple chronic condition. I got maybe I say high blood pressure, I have diabetes. How does that different?

00:25:49 Speaker 2

Yeah, well, it wouldn't differ too much from what I mentioned, but then you know, with a additional chronic disease, for example, we mentioned diabetes, then that may mean. Taking note of what we said above, but also maybe taking into attention your blood sugar pre and post exercise, so this would just help regulate your you know, you’re your prepare your body better for the bout of exercise.

00:26:18 Speaker 1

Okay, so as we are discussing on the safety of exercising, so in our lab we do have the participants to fill up a safety clearance form, you know, before they even embark in our exercise class. Now, this will give us. An idea of where they are at if they are required to seek medical condition, medical reference before exercising, and of course, which intensity they should exercise at.

00:26:40 Speaker 1

I think something that is publicly available, you know, for someone to do their own safety checks will be the Get Active questionnaire, which is, of course, at Sports Singapore's website. You know, is to access, assess them if they are fit for activity, and I believe the questionnaire comes in different languages, so it's suitable for everyone. To do a quick check, you know before they engage in their exercise. Doctor Mandy, let's move on to some myths and practical tips.

00:27:06 Speaker 1

Alright, so we hear in the news about fit or strong people getting to cardiac arrest. Is that something that someone needs to be concerned about?

00:27:17 Speaker 2

Yeah, so we sometimes hear about, you know, really fit people going through a marathon or a vigorous bout of exercise, and then suddenly dropping dead. And this can be really really scary, right, but I would like to assure you, and also the audience that this risk is very, very low.

00:27:37 Speaker 2

So when we look at some studies from one particular one from the New England Journal of Medicine, they found that the risk was about one in 1.5 million episodes of vigorous exercise. So while it can be scary, the absolute risk is very low, and actually exercising it's safer than not exercising, cause then you have a lot more chronic disease, comorbidities, and you know, other problems will arise.

00:28:08 Speaker 1

Yeah, all the other complications will start to sink in. Right, ya, ya. So I think exercise in general is safe, but of course, if you're unsure, definitely do check out with a professional healthcare first. Then you want to start exercising as what Doctor Mandy said, start low, go slow. Alright, so for the second myth, if someone who has hypertension and also high cholesterol, should they only do? Like light intensity, so not moderate, not vigorous, just light intensity.

00:28:33 Speaker 2

So this is a common misconception. I think when someone is being diagnosed with a new condition, sometimes you have, you're very weary and you're afraid to push yourself too much, but in reality, moderate intensity is safe for people who have high blood pressure and cholesterol conditions. The important thing is to slowly gradually build up.

00:28:58 Speaker 2

You can start low, go slow, but moderate intensity is very well studied and you know, well tolerated by our patients, and a lot of studies would show that moderate intensity is indeed the intensity that someone should be exercising in to reap the benefits.

00:29:18 Speaker 1

Yup, so again in moderate intensity is you're able to talk while exercising, and of course not be able to sing your favourite song. And as per the Singapore Physical Activity Guidelines, which you hit for at least 150 to 300 minutes of moderate intensity exercise. Yeah, if you're measuring at a vigorous intensity, there will be two times of moderate intensity. Yeah, okay, so lastly, there's quite closely to me, you know, my loved ones have a medical condition. How can I get them to start exercising?

00:29:46 Speaker 2

Yeah, that's a wonderful question, cause I face that with my family as well. I think the first thing would be to encourage your family members to start exercising. First, be a buddy for them, so bring them for the activity that you like or they like, or something the best that both of you enjoy. Yeah, so buddy up as a system and choose an activity that both of you enjoy. I think that would make a good combination of getting our loved ones on this journey with us.

00:30:19 Speaker 1

Yeah, I think I hear a lot of social support, you know, I think the key again is to bring your family member out of the house. Starting is the key again is the hardest, but once you get there, I think it will be a easy one after that. Okay, so thanks for sharing all the information earlier on. I think it's very beneficial for the listeners as well.

00:30:39 Speaker 1

So finding the activity that you enjoy doing most, I think is the best way to stay, adhere to exercise, and it's one of the many steps you know to lead a healthier and active lifestyle. You know, as I always tell people, health and wellness is not a, it's not a sprint, it's a marathon. So it's a journey that you know we have to tweak tweak, small little tweaks here and there to fit in our lifestyle to make it easier for us to be to stay on track. You know, so be patient, and of course, definitely enjoy the process right.

00:31:07 Speaker 1

Of course, in addition, active health coaches like myself, we do attend the EIM courses, so we are able to prescribe exercises for common medical conditions and help you to start sustain your health and wellness journey, you know. Feel free to book a session with us if you want to get started. Okay, doctor, mandy, let's move on to the question and answer from the audiences. Okay, so let me read off the first question to you. Is there any specific exercise or exercises that will help bring down cholesterol?

00:31:41 Speaker 2

Yeah, so we go for aerobic exercises, so I think that's the broad term of it, and we talked about FITT, right, so F for the frequency. So for cholesterol per se, I would recommend about thirty to sixty minutes of exercise three to five times a week.

00:32:04 Speaker 2

The intensity should be in a moderate intensity where you know, as Rui Jie mentioned, it can be a talk test where when you perform the bulk of exercise, you're able to talk, but not sing. The other way of managing or measuring intensity would be if you grade an exercise from zero, being the easiest and ten being the hardest, you should be exercising in about three to four intensity.

00:32:31 Speaker 2

Yup, and then the type would be aerobic, and aerobic exercise would be your cardio exercise. This could be walking, running, swimming, cycling, rowing, so something that you enjoy, something that you have access to. This would be a a great start to it.

00:32:51 Speaker 1

Okay, thanks for sharing, doctor, Mandy. Okay, let me move on to the next one, diabetic and menopause, so the question is, no matter how healthy one's try to live, will they still have high blood pressure?

00:33:04 Speaker 2

Well, I think high blood pressure, the thing about it is it's multifactorial, so we have genetic components as a risk factor, so that one we can't avoid. But of course, we also have other things where lifestyle could play a role, and so if we could manage, losing some weight, managing, managing alcohol intake, salt intake and exercising regularly, I actually do see some decrease in blood pressure in our patient. Yup, nonetheless, you know, stress could also be another factor. So if we can manage all this lifestyle factors, there will be a better chance of lowering it down, but nonetheless, everyone's quite different.

00:33:53 Speaker 2

And I would say you know good to monitor your blood pressure regularly, and as I mentioned in the top three here, age is one of a risk factor for high blood pressure, so as we age, inevitably the blood vessels will stiffen. Our blood pressure will increase, and that is something that we can't defy, cause we can't defy age.

00:34:13 Speaker 1

Yup, okay, so hope, hopefully that answers your question. Alright, the next one I heard, there are different types of cholesterol, LDL, VLDL. Are. There are different types of tests to measure cholesterol apart from lipid test. What's the most accurate?

00:34:31 Speaker 2

So that's probably a little bit out of my realm, because this is we're talking more about exercise. So you know, I think all these blood profiles, please speak to your your general practitioner or endocrinologist, so that they can you know, go through some of these blood test and blood profile, because there are some other new development in lipid profile. That's that's brewing in the background.

00:34:56 Speaker 1

Okay, thank you for that. Okay for exercising, may I ask which is more effective exercise? Thirty minutes, three days, or 45 minutes, two days.

00:35:06 Speaker 2

Yeah, well, now, I guess three and two. It, it, the bottom line, it, it doesn't really quite matter if it's three days or two days, as long as you have the volume in the week. But there's a little caveat to that.

00:35:24 Speaker 2

So if you're exercising for high blood pressure, for example, we know that exercise helps to decrease blood pressure, but the effect last about 24 to 48 hours, and therefore, if we want to maintain a good steady state of blood pressure throughout the week, then we have to do exercise more regularly, and this would mean maybe every day or every other day to reap the benefits of exercise for high blood pressure.

00:35:54 Speaker 2

Now, if you are doing it mainly for fitness or getting fit, and you don't have any chronic problems or chronic issues, then perhaps just getting 150 minutes, even just over the weekend, or as best as you can during the week would be sufficient.

00:36:13 Speaker 1

Yeah, so I think for exercise wise, there's no, no fixed amount, okay, depending on your condition as well. So like what Doctor Mandy has mentioned, if you have high blood pressure, you want to really exercise at a moderate intensity for every other day so that you can reduce your overall blood pressure, especially the systolic point by eight to ten. And of course, if you are there for general wellness, general health and wellness, I think the SPFG guideline will be a good starting point. Absolutely, ya. Of course, if you're athlete, then there will be a whole different story, right?

00:36:42 Speaker 2

Okay, performance, and you know, optimisation.

00:36:46 Speaker 1

Ya, ya, ya, correct. Okay, so I think the next question would be, is it safe to exercise if someone has an acute infection, example, if it's someone who is on antibiotics.

00:36:52 Speaker 2

Ya, well again, it depends where your infection is, so if it's involving, if you're saying more like a chest infection, then you know, I would say, and you are having fever, you're having chills. You're having a little bit of, you know, you really don't feel yourself. You know, feel the best self, then take it easy.

00:37:22 Speaker 2

Right, the general rule is if the infection is above the head, so it's just like a throat, a bit of a sinusitis. Ya. You can continue some bout of exercise, maybe lower intensity, lower duration, but if it involves anything below the the the neck, so involving the chest and you have a chest infection, there's you know, things could be as worse as pneumonia, and depending on what you're you're asking, then I would say, take a break until you're much better.

00:37:51 Speaker 2

The other form of infection would then be you know, if you have an infection of a knee joint or any parts of the body that's that's going to be a main loading point while you exercise, then highly recommended that we wait out the infection before starting on the exercise.

00:38:07 Speaker 1

Ya again, if we are unsure, definitely do check out again before you start exercising, cause we don't want to just make guesses whether we can or not. So of course, just go to a GP and get your condition cleared before you start exercising again. I think that's the safest advice that one can can give. Ya. Okay, so the the next one will be if someone some, if sorry, if exercise sometimes lead to light headedness, is the intensity too much for me?

00:38:36 Speaker 2

Ya, so there are different reasons for light headedness, right, so maybe the 1st question is, do you have any chronic condition? So for example, we know that low sugars may cause Light headedness, high blood pressure can cause light headedness, but I think if you do have such symptoms, I would say spend a little bit more time on your warm up and gradually build into the exercise belt rather than jumping into that. Another time I tend to see my patients complaining about light headedness is when they suddenly stop a high intensity exercise too abruptly.

00:39:23 Speaker 2

Okay, okay, and that's because when you are and doing it something at high intensity and then you suddenly stop. Maybe think about it like you go for a spin class. Right, it's a high intensity exercise, you have the music, you have the adrenaline, you're on the bike, and then if you suddenly come off the bike without cooling down, there is a pooling of blood from the brain down to the toes, and we call this more like a postural hypotension or postural drop of blood pressure.

00:39:51 Speaker 2

And often this may cause a little bit of the dizziness. Now, to prevent this from happening, we would then say Okay, spend a little bit more time on your cool down. You know, gradually come down to baseline, and this may help prevent and avoid the light headedness.

00:40:08 Speaker 1

Yeah, I think that's a very well explained answer. Thank you, doctor Mandy. So the next question will be as a chronic diabetic patient. How do one prevent from getting low blood sugar during exercise, such as brisk walking?

00:40:21 Speaker 2

Yeah. Well, I guess first things first, if you do think that you have low blood sugar while exercising, I would urge you to monitor your blood sugar levels before, during and after the bout of exercise, just to make sure that it's indeed low blood sugar and not a perceived feeling of low blood sugar.

00:40:44 Speaker 2

And the good news is, if you do find that you have low blood sugar while exercising, then it may mean that we could potentially reduce your medication. Oh, okay. Because whatever medication they are on, maybe a little bit, you know, maybe a little bit too strong now that you're already exercising. Yeah, so there's a potential that we can titrate or decrease your blood sugar.

00:41:10 Speaker 2

But I think your endocrinologist or your doctor would like to know your blood sugar levels so that we can titrate and adjust your medications accordingly.

00:41:19 Speaker 1

Okay, thanks for sharing that. I think we can have one last question. Let me take a look at the. Why are spikes in blood pressure? Sorry. Why are spikes in blood pressure in exercise? No, okay, let me rephrase it. Why are sudden spikes in blood pressure during exercise is not good, and is high intensity exercise bad.

00:41:42 Speaker 2

Yeah, so we, when I gave the example of sudden spikes, that's not great. It's mainly for our patients with high blood pressure. So people with high blood pressure, they have dysfunction in their blood vessels already, so with a sudden spike it tends to weaken it. So if you are otherwise healthy, then you know our body is usually able to accommodate such spikes.

00:42:09 Speaker 2

And yeah, really, we're talking for the chronic condition patients, and it's not that it's not good, but we want to manage them in a more graduated manner. Because a sudden spike could sometimes throw off, you know, other cardiovascular risk affecting the brain, the heart. But again, if you're healthy, otherwise normal, that's usually not a problem.

00:42:34 Speaker 1

Okay, thank you, doctor Mandy, for answering the questions. So if I may sum up the things that we have discussed today, I think we learn that how exercise can be a very powerful tool in managing chronic conditions, such as high blood pressure, diabetes, as well as high cholesterol, and you also shared with us that starting small and staying consistent is the key to long term health.

00:42:57 Speaker 1

And definitely, when you are starting your fitness journey or supporting a loved ones, find something that you enjoy and you will stick with it. Alright. Of course, it's all about gradual process. As you mentioned earlier, start low, go slow. I think that's my favourite phrase for today. For more support, of course active health coaches are here to help, and we have nine labs across the island.

00:43:18 Speaker 1

And Doctor Mandy, once again, thank you so much for your time and sharing your expertise with us on how to be physically fit and benefits of being active. You know, I believe our listeners have deepen their knowledge about how physical activity can help in managing this chronic conditions. Okay, so on screen right now you will be able to see active health targeted programs as well as move better programs to get you started on your exercise journey. Okay, you can scan the QR code on screen right now. To find out more, so I'm just going to leave it here for maybe about ten seconds.

00:43:59 Speaker 1

Alright, so for those who have actually missed the previous episodes of our podcast talking about nutrition, HYROX training and sleep, you may also scan this QR code, or you can take a snapshot of it and scan it later on. So the same thing, I'm just going to leave it here for about ten seconds.

00:44:23 Speaker 1

Alright, and lastly, follow us on our social media account for upcoming exciting events by scanning the QR code again. I know there's a lot of QR code, so don't be confused. Take some pictures if you need to. Okay, we will be posting exercise tips on how to live actively and stay strong, and once again, stay active, stay healthy, and we will see you at Active Health Lab for workout session. Thank you, doctor Mandy. Thank you all. Bye.

00:44:47 Speaker 2

Thank you.