AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Vitamin D is essential for the proper development of bones. Vitamin D deficiency can lead to cardiovascular diseases, loss of bone density, and osteoporosis.

All About Vitamin D

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Ismail Munir

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Time To Hit The Gym, Your Bones Are Calling!

Introduction

The term &quot;<a href="https://www.merisehat.pk/disease/osteoporosis-80">osteoporosis</a>&quot; literally translates to &ldquo;porous bone&rdquo;. Osteoporosis occurs when the bones lose minerals more quickly than they can be replaced. This causes the bones to become less dense, weak, and break more easily. The disease thins the bone framework. As a result, even a minor fall or bumps against furniture can cause a fracture. 
&nbsp;

For most people, the disease takes a silent course and they remain unaware of its presence until a fracture happens. Since osteoporosis generally does not present with any signs and symptoms, it is often referred to as the &ldquo;silent disease&rdquo;.&nbsp; 
&nbsp;

Osteoporosis is a common bone disease that affects both men and women, but middle- and older-aged women are more likely to have it as compared to men. In postmenopausal women, low estrogen levels increase the risk of disease. Moreover, the prevalence of the disease increases with age. 
&nbsp;

Osteoporosis typically presents with fractures and its associated complications. Spine, hip, and wrist fractures are the most common fractures in osteoporosis. Additionally, limited activity because of postural changes affects the individual&rsquo;s overall quality of life.&nbsp;&nbsp;

&nbsp;

Bones are formed by special cells in our body, called osteocytes. Similar to other parts of our body, our bones are also constantly being broken down and renewed. When we are younger, more bone is made than is broken down, which leads to bone growth. However, with age, the bone growth slows down and by the age of 25 to 30 years, it completely stops. This is the time around which peak bone mass is achieved.&nbsp; 
&nbsp;

In addition, sex hormones, such as estrogen and testosterone, play a pivotal role in maintaining bone strength in both men and women. However, during menopause, there is a significant decrease in the levels of estrogen. This triggers excessive bone loss. Women can lose as much as 10-20% of the total body bone mass during the first few years of menopause<a href="#accordion">[1]</a>. 
&nbsp;

Osteoporosis also triggers fractures of the spine that can cause pain, changes in posture, and loss of height. Similarly, when spinal fractures are compressed because of the force of gravity, it causes the spine to bend abnormally, a condition that is known as kyphosis.&nbsp; 
&nbsp;

Understanding The Importance Of Exercise in Osteoporosis

Fortunately, there are preventive measures and treatments available to combat this problem. Lifestyle changes and medical treatment can help reduce the risk of bone fractures and slow down further bone loss. Early diagnosis and fracture risk assessment can slow down the loss of bone density in people with osteoporosis. 
&nbsp;

Moreover, just like muscles gain strength from exercise, bones can also become stronger with physical activity. Exercising may be effective for the treatment of osteoporosis and the prevention of hip and spinal fractures. Studies have further shown that weight training prevents age-related decline in skeletal mass, and in some cases may also increase the mineral content of bones.&nbsp; 
&nbsp;

Exercising regularly helps with optimal improvement in bone density, even in women taking adequate dietary calcium. The skeletal benefits of exercise are not affected by hormonal status or age. Exercise programs are designed keeping in mind the individual’s physical condition, the current level of activity, their overall compliance, and objectives that need to be achieved. Generic programs that aren’t specifically designed to target the needs of the individuals and inadequate supervision will result in musculoskeletal complications and non-compliance. Moreover, exercise helps prevent osteoporosis-associated complications, irrespective of age and hormonal status.

<h4>"Hitting the gym when anxious can help calm you down. And our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> can help you monitor your stress level!"</h4>

Each year, more than 2 million osteoporosis-related fractures are reported. What&rsquo;s more, most people are unaware of the fact that they have osteoporosis till they suffer a fracture. 
&nbsp;

While the exact cause of osteoporosis is still not known, there are many factors that contribute to osteoporosis, including:&nbsp; 
&nbsp;

<ul>
	<li>Ageing&nbsp;</li>
	<li>Lack of physical activity and an inactive lifestyle&nbsp;</li>
	<li>Decreased levels of estrogen&nbsp;</li>
	<li>Genetic predisposition&nbsp;</li>
	<li>Excessive use of thyroid hormone and cortisone&nbsp;</li>
	<li>Smoking&nbsp;</li>
	<li>Excessive intake of alcohol&nbsp;</li>
</ul>

&nbsp;

The loss of bone generally begins at the age of 35 and is more commonly seen in the lower forearm above the wrist, spine, and upper femur or thigh. Women lose 30-50% of their bone density after growth is complete, and men lose 20-30%<a href="#accordion">[1]</a>. The common osteoporosis-associated injuries in older adults include wrist fractures, spine fractures, and hip fractures.&nbsp;

During menopause, women lose calcium from the bone at a more accelerated pace compared to men. This results from the low estrogen levels during menopause.&nbsp; The hormone helps maintain bone mass and strength. Your doctor may recommend estrogen replacement therapy or other medications such as calcitonin.&nbsp;

&nbsp;

Moreover, certain medical conditions, medications, and treatments can also affect the strength of bones directly. Vitamin D deficiency, endometriosis, cancer, chronic lung disease, and an overactive thyroid or parathyroid gland can all affect bone density. Other risk factors include:&nbsp; 
&nbsp;

<ul>
	<li>Low intake of protein, potassium, vitamin D or calcium&nbsp;</li>
	<li>Inactive lifestyle&nbsp;</li>
	<li>Cigarette smoking&nbsp;</li>
	<li>Alcohol abuse&nbsp;</li>
	<li>Long-term use of medications such as some antiseizure drugs, or overuse of aluminium-containing antacids and glucocorticoids.&nbsp;</li>
	<li>Eating disorders&nbsp;</li>
	<li>Low levels of estrogen in women and testosterone in men</li>
</ul>

&nbsp;

Whether you&rsquo;re in your early 20s or late 50s, keeping the bones healthy at any age is a smart goal. However, people only realize the importance decades after they turn 50. Or when weakened bones have already led to fractures. 
&nbsp;

Fortunately, regular moderate-intensity exercise, for at least 2 hours and 30 minutes every week, can help reverse the damage. Fast walking and cycling are both examples of moderate-intensity exercise. Moreover, weight-bearing and resistance exercises help improve bone density and prevent osteoporosis. Similarly, it is also recommended for adults between the ages of 19 and 64 to do muscle-strengthening activities at least twice a week. The exercises target major muscle groups including the back, shoulders, chest, arms, hips, and legs.&nbsp; 
&nbsp;

If you have been diagnosed with osteoporosis, speak with your doctor before starting any new exercise regimen to ensure that it&rsquo;s the right fit for you.&nbsp; 
&nbsp;

<h5>1. Weight-Bearing Exercises&nbsp;</h5>

Weight-bearing exercises are tailored for your feet and legs to support your weight. High-impact weight-bearing exercises, for example, aerobics, dancing, skipping, running, and jumping up and down on the spot will help in strengthening your muscles, joints, and ligaments. Though, while exercising it is essential to wear footwear that provides your ankles and feet with adequate support. Moreover, weight-bearing exercises are also the perfect fit for people over the age of 60. The exercises can include brisk walking or a game of tennis.&nbsp; 
&nbsp;

<h5>2. Resistance Exercises&nbsp;</h5>

Resistance exercises are designed to strengthen muscles and improve bone density. Examples of resistance exercises include weightlifting, press-ups or exercise using other weight training equipment at the gym. If you have never exercised at a gym before, always ask for help from an instructor to ensure correct use and prevent any injuries.

&nbsp;

Conclusion

Ageing and declining hormone levels are normal physiological phenomena. But that should not be used as an excuse to live an unhealthy or sedentary lifestyle. While you may not feel as physically fit as when you were in your 20s, it’s never too late to hit the gym and reverse the damage. Studies have shown that exercising regularly can help improve bone density and prevent fractures.&nbsp;

[1].Ji, M.X. and Yu, Q., 2015. Primary osteoporosis in postmenopausal women. Chronic diseases and translational medicine, 1(01), pp.9-13.

Staff Writer

Iqra Mazhar

All Work No Play Makes Jack A Dull Boy And Jill A Dull Girl

Physical activity is very important for a child&rsquo;s health. Children and adolescents who are active now are more likely to be active adults later. That&rsquo;s why it is imperative to promote an active lifestyle among children at an early age.

On one hand, a lack of movement is associated with obesity, <a href="https://merisehat.pk/disease/depression">depression</a>, and <a href="https://merisehat.pk/disease/anxiety">anxiety</a>, while on the other hand,&nbsp;physical activities have a positive impact on the social and psychological aspects of an individual&rsquo;s personality.&nbsp;

The sad reality is that more people are adopting a sedentary lifestyle these days. Staying indoors and spending time at home has become a norm. Children, especially, have become couch potatoes because they spend most of their time on their computers or tablets. This makes them dull and declines their cognitive skills or stamina. The only physical activity they indulge in is physical education (PE) at school, which unfortunately is optional, and not every child enrolls in it.&nbsp;

&nbsp;

Understanding Importance Of Childhood Physical Activity

It&rsquo;s unfortunate that despite knowing its benefits, there is a lack of physical activity among children in Pakistan. Parents play a crucial role in teaching their children the importance of physical activities. However, most of them are uninformed and are unable to persuade their children to indulge in healthy activities. So, parents should first acquaint themselves with the subject, before they talk to their children and encourage them to take up physical sports.

&ldquo;Active 1 + FUN&rdquo;, for instance, is one family-based intervention that has proven to be helpful. It&rsquo;s the parent&rsquo;s choice whether they prefer online materials or real-time interactive workshops to meet their child&rsquo;s basic psychological needs<a href="#accordion">[1]</a>. Parents exploring fun activities with their children can be a good bonding moment between the two, which can also enhance cooperation between them.&nbsp;

&nbsp;

Promoting physical activity among adolescents and children is very important for their growth and development. Additionally, it improves academic and cognitive performances. The World Health Organization emphasizes that children between the ages of 5 and 17 should spend at least 60 minutes per day on high-intensity physical activities, but only 20% of the children follow this rule of physical activity<a href="#accordion">[3]</a>. Furthermore, it was seen that girls between the ages of 13 and 15 lack physical activity in their daily routines compared to boys, and only 15.5% of them engage in it.&nbsp;

There are multiple reasons why children are inactive. For one, social norms and patriarchal ideologies in Asian countries deprive girls of taking part in sports activities or any other activities that require physical training. This has led to false perceptions perpetuated among teenage girls who think that games are only for boys.&nbsp;

Secondly, girls are more inclined toward social media, trending movies, and TV shows, while boys prefer online gaming<a href="#accordion">[4]</a>. However, the tide has been fast shifting and we now see both girls and boys enjoying sports and indulging in online gaming.&nbsp;

Unfortunately, for many children, they continue to lead a monotonous life, which involves school, homework, and lazing around at home in their free time.

&nbsp;

Circumstances are not always favorable for most children, considering the inflation and other constraints in our country. Here are some budget friendly activities that can be done:

<ul>
	<li>Drawing: Chalks can be a fun activity for children. Children can draw a maze on the floor or play hopscotch like the kids from the 90s. This activity is an encouragement for creativity and fitness.</li>
	<li>Dancing: The simplest way to get the kids moving is to play music and make them dance to the tunes. Parents can also engage in the activity with their kids. Studies show that dancing improves a person&rsquo;s health, calms them, and helps them sleep better at night<a href="#accordion">[5]</a>. Also, dancing is quite useful in reducing anxiety and depression<a href="#accordion">[6]</a>.</li>
	<li>Board Games: Board games are a great way to promote early learning in children. They help them identify colors,&nbsp;and develop hand-eye coordination and math skills.&nbsp;</li>
</ul>

&nbsp;

<h4>"Exercise is vital to managing stress. Find out your stress level with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan </a>today!"</h4>

<ul>
	<li>Limit Screen Time: Parents should limit their children&rsquo;s screen time, which includes video games, tablets, and smartphones. If children are under the age of 5, their screen time should be less than 1 hour per day. Moreover, screen time is not recommended for kids under 2 years.</li>
	<li>Organised Sports: Organised sports, like football or cricket, are not enough to keep your children healthy. It&rsquo;s important to encourage them to stay active every day &ndash; a walk in the park and jumping rope are low-cost exercises that they can opt for.</li>
	<li>Skip The Elevator: When parents are out with their kids, they should encourage them to use the stairs instead of the elevator.&nbsp;</li>
	<li>Make Them Help Out: Whether it is grocery shopping or doing house chores, letting the children help ensures they are not only active but also learn essential life skills.</li>
</ul>

&nbsp;

<ul>
</ul>

<ul>
	<li>Growth: Exercise is as important as food for children to grow. It helps to build stronger muscles and bones. A healthy bone density or bone mass reduces the risk of bone-related diseases, such as osteoporosis, later in life.</li>
	<li>Better Fitness: Exercise helps build physical strength, which has multiple benefits for growing children. For example, they can walk longer distances and not get tired, they are more active, and they perform everyday tasks without getting lethargic. Additionally, exercise promotes stability and flexibility.</li>
	<li>Motor Skills: Physical activity builds motor skills that help children master basic movements. Motor skills include all tasks like feeding themselves, writing, and getting dressed.</li>
	<li>Posture: Children are habitual of slouching and exercise can improve their posture through core strength. Moreover, it protects the spine from deformity&nbsp;and reduces pain due to bad posture.</li>
	<li>Cognitive Development: Exercise helps in brain development. During exercise, the nerve cells in the hippocampus and the prefrontal cortex of the brain multiply to form new connections<a href="#accordion">[7]</a>. This improves concentration and memory, which are the basic needs of every child.</li>
	<li>Mental Health: Although most children dread exercising, it helps in relieving stress and anxiety<a href="#accordion">[8]</a>. The endorphin rush promotes a better mood.</li>
</ul>

&nbsp;

Key Points

<ul>
</ul>

<ul>
	<li>Physically active kids are happier kids.</li>
	<li>Exercise strengthens the bones and muscles, and prevents the children from gaining excess weight. Consequently, it reduces the risk of other diseases, like diabetes, osteoporosis, and cancer.</li>
	<li>Physical activity is also beneficial for mental health.</li>
	<li>Exercise also enables children and adolescents to have a better outlook on life. They are confident and have better cognitive and stress management skills.</li>
	<li>The release of endorphins during exercise positively correlates to happiness in children.</li>
</ul>

&nbsp;

[1] Ha, A.S., Ng, J.Y., Lonsdale, C., Lubans, D.R. and Ng, F.F., 2019. Promoting physical activity in children through family-based intervention: Protocol of the “Active 1+ FUN” randomized controlled trial. BMC Public Health, 19(1), pp.1-12.

[2] Habib, M.B., Nazeer, M.T., Mahfooz, M. and Safdar, M.S., 2022. Physical activity in Pakistani perspective: issues, implications, and recommendations. Journal of the Pakistan Medical Association, 72(2), pp.322-328.

[3] Imtiaz, A., ulHaq, Z., Afaq, S., Khan, M.N. and Gillani, B., 2020. Prevalence and patterns of physical activity among school aged adolescents in Pakistan: A systematic review and meta-analysis. International Journal of Adolescence and Youth, 25(1), pp.1036-1057.

[4] Lu, A.S., Baranowski, T., Hong, S.L., Buday, R., Thompson, D., Beltran, A., Dadabhoy, H.R. and Chen, T.A., 2016. The narrative impact of active video games on physical activity among children: a feasibility study. Journal of medical Internet research, 18(10), p.e6538.

[5] Gyrling, T., Ljunggren, M. and Karlsson, S., 2021. The impact of dance activities on the health of persons with Parkinson’s disease in Sweden. International Journal of Qualitative Studies on Health and Well-being, 16(1), p.1992842.

[6] Adam, D., Ramli, A. and Shahar, S., 2016. Effectiveness of a combined dance and relaxation intervention on reducing anxiety and depression and improving quality of life among the cognitively impaired elderly. Sultan Qaboos University Medical Journal, 16(1), p.e47.

[7] Bidzan-Bluma, I. and Lipowska, M., 2018. Physical activity and cognitive functioning of children: a systematic review. International journal of environmental research and public health, 15(4), p.800.

[8] Alves, J.M., Yunker, A.G., DeFendis, A., Xiang, A.H. and Page, K.A., 2021. BMI status and associations between affect, physical activity and anxiety among US children during COVID‐19. Pediatric obesity, 16(9), p.e12786.

Humza Khizer

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

I Like To Move It, Move It. Do You?

In arthritis, it is necessary to participate in joint-friendly physical activity to improve arthritis pain, mood, function, and quality of life. Choose activities which place less stress on the joints and are associated with a reduced risk of injury. Walking, biking and swimming are examples of joint-friendly activities. Being physically active can also delay the onset of arthritis-related disabilities and help with the management of other chronic conditions (diabetes, heart disease, and obesity). 
&nbsp;

These exercises should be revisited if there is a change in symptoms.&nbsp;

It is important to learn how to exercise safely and enjoy the benefits of increased physical activities with these &ldquo;SMART&rdquo; tips. 
&nbsp;

<ul>
	<li>Start low, go slow.</li>
	<li>Modify activities according to the severity of symptoms.</li>
	<li>Activities should be &ldquo;joint-friendly.&rdquo;</li>
	<li>Recognize ways to be active.</li>
	<li>Talk to a health professional. 
	&nbsp;</li>
</ul>

<h5>Start Low, And Go Slow</h5>

When starting or increasing physical activity, start slow and pay attention to how the body tolerates the exercise. People with arthritis will take more time for their bodies to adjust to the new level of activity. In the beginning, it is much better to start with a small amount of activity, for example, 3-5 minutes. Add a little at a time (like 10 minutes at a time), and allow sufficient time for your body to adjust to the new time frames introduced, before adding more time. 
&nbsp;

<h5>Modify Activities According To The Severity Of Symptoms And Stay Active.</h5>

Arthritis symptoms (stiffness, and fatigue) may come and go, and the affected person may have good and bad days. Try to modify your activity according to these highs and lows, but try to stay as active as possible, in a safe way.

&nbsp;

<h5>Activities Should Be &ldquo;Joint-Friendly.&rdquo;</h5>

Exercises should be easy on the joints. Walking, bicycling, water aerobics, or dancing are good examples of activities which have a very low risk of injury, and do not place undue stress on the joints.

&nbsp;

<h5>Recognize Ways To Be Active.</h5>

Safety is very important for starting and maintaining an activity plan. Before starting any exercise, it is advisable to consult a professional. You can also start with joining group classes offered by certified trainers. In case you decide to opt for making an exercise plan yourself, then ensure all safety measures are in place. For example, if your exercise plan is centered around walking, then use a route which is levelled, free of obstructions, well-lit and away from heavy traffic.

&nbsp;

<h5>Talk To A Health Professional</h5>

Your doctors can help you design personalized activity plans/goals along with addressing any related concerns.&nbsp;

&nbsp;

Here are some examples of exercise that you can choose:

<ul>
	<li>
	<h5>Low-Impact Aerobics Activities</h5>
	</li>
</ul>

These activities will not put stress on the joints and they include brisk walking, light gardening, group exercise classes, cycling, swimming, water aerobics, and dancing. 
&nbsp;

<ul>
	<li>
	<h5>Muscle-Strengthening Exercises</h5>
	</li>
</ul>

&nbsp;You can add some muscle-strengthening activities using light weights in your workout routine. Working with resistance bands and yoga could be a good alternative to explore on days when you are not in the mood for a walk on the treadmill.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Flexibility Exercises</h5>
	</li>
</ul>

&nbsp;These are recommended for people with arthritis. Many people with arthritis have stiff joints that make daily tasks difficult. Doing daily flexibility exercises will help to maintain their range of motions. 
&nbsp;

<ul>
	<li>
	<h5>Balance Exercises</h5>
	</li>
</ul>

Standing on one foot, walking backwards, and tai chi are some exercises recommended for arthritis patients with balance issues.&nbsp;

&nbsp;

It&rsquo;s normal to have a little pain, stiffness, and swelling after starting a new physical activity plan. It may take 6- 8 weeks for joints to get used to the new activity level, but sticking with the activity program will result in long-term relief in pain. 
&nbsp;

Here are some tips to manage pain during and after physical activity to stay on track with your activity plan:&nbsp;&nbsp;

<ul>
	<li>Continue modifying your physical activity program by exercising less frequently (fewer days a week), or for shorter periods of time (less time for each session) till you experience pain relief.&nbsp;</li>
	<li>Try different types of exercises that are joint friendly, for example, switch from walking to water aerobics.</li>
	<li>Proper warm-up and cool-down before and after exercise is essential.</li>
	<li>Exercise at a comfortable pace</li>
	<li>Use well-fitted and comfortable shoes.</li>
</ul>

&nbsp;

<h4>"Exercise releases endorphins, which help reduce stress. Try our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan </a>to monitor your stress level!"</h4>

Understanding importance of exercise for arthritis patients

For people with rheumatoid arthritis (RA), exercise is hugely beneficial for relieving pain and joint stiffness. 
&nbsp;

People with RA who exercise will find that they have less pain than those who do not. Exercise reduces painful symptoms, improves flexibility &amp; joint functions, increases range of motion, and boosts mood. 
&nbsp;

It is best to seek medical advice before starting any type of exercise plan, and work with a doctor and physical therapist to develop a proper exercise plan.

&nbsp;

The following types of exercise may help to get relieved the pain, joint stiffness, and other symptoms of RA: 
&nbsp;

<ul>
	<li>
	<h5>Stretching</h5>
	</li>
</ul>

Stretching can&nbsp; improve flexibility, increase range of motion and reduce stiffness. Daily stretching is important for relieving RA symptoms.

The ideal stretching routine is different for each person. The routine depends on which joints are affected and what symptoms occur. Stretches often involve slow and gentle movement of the joints of the knees, hands, and elbows.

&nbsp;

A typical stretching routine consists of:

<ul>
	<li>Warm-up by walking in place or pumping the arms while sitting or standing for 3 to 5 minutes.</li>
	<li>Hold each stretch for 20 to 30 seconds before releasing it. 
	&nbsp;</li>
</ul>

Repetition of each stretch 2 to 3 times. Yoga straps will help people maintain proper form while stretching. A dog leash is an alternative to yoga.

It is beneficial to work with a physical therapist who understands RA to learn the correct way to perform these stretches. 
&nbsp;

<ul>
	<li>
	<h5>Walking</h5>
	</li>
</ul>

Walking is a low-impact form of exercise that helps with aerobic conditioning, heart and joint health, and mood.

It is essential to stay hydrated and wear proper shoes, even if the walking is not strenuous. It is recommended to walk slowly initially, and then increase the pace gradually. 
&nbsp;

<ul>
	<li>
	<h5>Flowing Movements, Like Yoga And Tai Chi&nbsp;</h5>
	</li>
</ul>

Both tai chi and yoga combine gentle poses, deep breathing, flowing movements and meditation. They increase flexibility, balance, range of motion, and also helpful in reducing stress. 
&nbsp;

<ul>
	<li>
	<h5>Pilates</h5>
	</li>
</ul>

Pilates increases flexibility for enhanced joint health and is a low-impact activity. Pilates can also help with stability.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Water Based Exercises</h5>
	</li>
</ul>

Water helps to support body weight by minimizing gravity, which means that water exercises do not place a lot of stress on the joints.

Water aerobics, swimming, and other gentle water exercises increase flexibility, range of motion, strength, and aerobic conditioning. They can also reduce joint stress and stiffness. 
&nbsp;

<ul>
	<li>
	<h5>Cycling</h5>
	</li>
</ul>

Cycling is extremely helpful for the improvement of cardiovascular functions. As RA patients are at risk of cardiovascular disease, it is vital to keep the heart as healthy as possible. 
&nbsp;

Riding a stationary bike is a safe way to get the joints moving while improving cardiovascular fitness.&nbsp;Cycling also helps in reducing stiffness, increasing range of motion, and building endurance. 
&nbsp;

<ul>
	<li>
	<h5>Strength Training</h5>
	</li>
</ul>

Strengthening the muscles around the affected joints can help to increase strength, while reducing pain and other RA symptoms. Using a resistance band is one way to challenge the body, and build muscle over time. 
&nbsp;

<ul>
	<li>
	<h5>Hand Exercises</h5>
	</li>
</ul>

RA sometimes leads to limited use of the hands. The person with RA may lose their grip strength and find that they are dropping things. Slowly curling the fingers, bending the wrists up and down, spreading the fingers wide on a table and squeezing a stress ball are some ways to help increase strength and flexibility in the hands. 
&nbsp;

<ul>
	<li>
	<h5>Gardening</h5>
	</li>
</ul>

Light gardening can be a beneficial exercise for a person with RA.&nbsp;

&nbsp;

The following tips will help to improve comfort and safety for exercising with RA: 
&nbsp;

<ul>
	<li>
	<h5>Be Consistent</h5>
	</li>
</ul>

People need to exercise consistently to achieve meaningful results. It is important to practice regularly. RA patients will certainly benefit from consistent and lifelong aerobic and muscle strengthening exercises. 
&nbsp;

<ul>
	<li>
	<h5>Accessorize For Comfort And Protection</h5>
	</li>
</ul>

The following methods can help people exercise more comfortably with less injury risk and falls: 
&nbsp;

<ul>
	<li>always use a slip-resistant mat for yoga</li>
	<li>wear comfortable clothes&nbsp;</li>
	<li>wear good supportive shoes for preventing injuries and maintaining balance</li>
	<li>Seek variety 
	&nbsp;</li>
</ul>

RA symptoms may vary daily, and tend to come in waves. People often face flares and periods of remission. Doing an exercise and mixing up the daily routine will help people to avoid overworking one set of muscles and particular joints. For example, a person doing morning stretches on a daily basis may choose to add strength training twice a week, a water workout once a week, and yoga or tai chi twice a week, if symptoms permit. 
&nbsp;

<ul>
	<li>
	<h5>Adjust Exercises According To Symptoms</h5>
	</li>
</ul>

You should adjust your routine according to your symptoms, for example if experiencing hand pain, place your resistance band around your forearms, instead of holding it in your hands. On painful days, switch from cycling or swimming to taking a leisurely stroll.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Listen To Your Body</h5>
	</li>
</ul>

Listen to your body! It is crucial to avoid discomfort or injuries. It is vital to listen to the body and choose the right pace. If exercise causes discomfort or a flare, reduce the session. Do 10 minutes rather than 30.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Pay Attention To Small Things</h5>
	</li>
</ul>

Most exercises focus on large muscular groups. It is essential to make time for smaller groups, such as the hands and fingers. It is also important to do exercises with your toes and feet. Exercises that help in maintaining balance are equally important such as yoga. 
&nbsp;

<ul>
	<li>
	<h5>Work With A&nbsp;Physical Therapist</h5>
	</li>
</ul>

Working with a physical therapist who specializes in RA is an absolute must. These professionals will develop safe and personalized routines for you. This collaboration is particularly beneficial for people with a new RA diagnosis and those who are experiencing a severe flare.

&nbsp;

People with RA should avoid all those exercises that cause pain and are strenuous. These may include high-impact exercises that put excessive strain on the joints.&nbsp;

&nbsp;

<ul>
	<li>Exercise is tremendously important for people with rheumatoid arthritis (RA).&nbsp;</li>
	<li>Exercise helps improve aerobic fitness, boosts mood, helps with daily functioning, relieves symptoms, builds strength, improves joint function and increases flexibility.</li>
	<li>Exercise helps with management of RA by reducing flares.</li>
	<li>A personalized exercise plan should be created after consulting your doctor and a licensed physiotherapist.&nbsp;</li>
</ul>

&nbsp;

Disclaimer: This article is intended to increase awareness about the benefits exercise offers to patients suffering from arthritis (especially rheumatoid arthritis), and is not a substitute for a doctor&rsquo;s advice. Consult your doctor and physiotherapist before starting any exercise.&nbsp;

&nbsp;

[1]. Physical Activity Guidelines for Americans

[2]. Medically reviewed by Amy Elizabeth Wolkin, PT, DPT, MBA — Written by Kat Gál — Updated on April 12, 2021

Zareena Mushtaq

&ldquo;If it&rsquo;s not neat or on the rocks, I am too old to drink that&rdquo;. z 
&nbsp;

But the thing is that osteoporosis, a disorder that causes bones to grow abnormally and become overly dense, does not come knocking on your bones after confirming the age, but it comes due to inappropriate amount of vitamin D in the body.&nbsp; 
&nbsp;

The recommended daily allowance (RDA) for vitamin D is 15 mcg per day (600 IU) for individuals who are 19 years old and above, regardless of their gender. However, for adults over 70 years old, it bumps up to 20 mcg daily (800 IU)<a href="#accordion">[2]</a>. 
&nbsp;

Vitamin D that comes from the skin or diet is in its inactive form and requires a 2-step process before it can be used by the body: 
&nbsp;

<ul>
	<li>Firstly, hydroxylation is carried out in the liver, where the enzyme vitamin D-25-hydroxylase (25-OHase) converts it into 25(OH)D.&nbsp;</li>
	<li>Secondly, 25(OH)D is subjected to further hydroxylation in the kidneys by the enzyme 25(OH)D-1-OHase (CYP27B1) to form the final active variant of vitamin D, namely 1,25(OH)2D. It is usually referred to as Cholecalciferol.&nbsp;</li>
</ul>

Moreover, vitamin D initiates the absorption of calcium in the gastrointestinal system, small intestine to be precise<a href="#accordion">[1]</a>. 
&nbsp;

Vitamin D always produces symptoms if it is not enough in the body. They would either be generalised or specific according to gender, age, and even routine sometimes.&nbsp; 
&nbsp;

Diseases relevant to vitamin D deficiency are extremely disturbing and definitely not worth it. On the other hand, prevention is extremely simple - adequate diet and ample exposure.

&nbsp;

Vitamin D deficiency is characterised into 3 types: 
&nbsp;

1. Mild (20-30 ng/mL)

2. Moderate (10-20 ng/mL)

3. Severe (&lt;10 ng/mL) 
&nbsp;

Studies prove that 1 billion people in the world go through vitamin D deficiency or insufficiency. A report presented by the National Health and Nutrition Examination Survey III (NHANES III) shows that 1% individuals in the US suffered from vitamin D deficiency, whereas 58% had insufficiency.&nbsp; 
&nbsp;

<ul>
	<li>Vitamin D deficiency is when a person&rsquo;s level drops to less than 7 ng/mL.</li>
	<li>Vitamin D insufficiency is when their levels are less than 25 ng/m. 
	&nbsp;</li>
</ul>

A study carried out in the South Asian region concluded that Pakistan had the highest prevalence, around 63-85%, followed by Bangladesh (50-83%) and India (61-73%)<a href="#accordion">[3][4]</a>.

&nbsp;

The major source for obtaining vitamin D is sunlight. Hence, if you do not go out in the sun enough, there is a huge probability you develop vitamin D deficiency, or VDD.&nbsp; 
&nbsp;

The physical activities of generation Z (anyone born between 1990 and 2010) have been consistently inconsistent because of their lifestyle, which revolves around indoor activities, surrounded by gadgets.&nbsp; 
&nbsp;

If only heated gadgets could also provide vitamin D. But till they don&rsquo;t, going out in the sun is the only option to avoid VDD. Use a sunscreen with a protection factor (PF) of 30 when you expose your skin to the sun.&nbsp; 
&nbsp;

Furthermore, an inadequate diet is why you might not have ample vitamin D in your system. People nowadays refuse to intake milk as it is apparently a &ldquo;child&rsquo;s drink&rdquo;, and they also avoid items like salmon, egg yolks and fruits. Everything is justified in balance; if you want to lose weight and do not have a pathological reason behind it, it is a much better approach to accommodate an egg yolk, so you up your vitamin D without increasing your calorie intake<a href="#accordion">[1]</a>.

There are theories that suggest that older people have fewer chances to get VDD, because mostly people of that age take supplements; hence, bridging the gap.

&nbsp;

Understanding Importance Of Vitamin D

<ul>
	<li>
	<h5>Protects Your Heart</h5>
	</li>
</ul>

Did you know that vitamin D plays a cardioprotective role in your body? Following a heart attack, it&rsquo;s likely you end up with scar tissue that debilitates the heart&rsquo;s functionality. This scar is developed by specialised cells called the cardiac colony-forming unit fibroblasts (cCFU-Fs). Vitamin D is a natural antagonist to stop cCFU-Fs from forming this scar. Thus, ensuring efficiency of the heart<a href="#accordion">[5]</a>.&nbsp; 
&nbsp;

<ul>
	<li><a href="#accordion">Reduces Risk Of Cancer</a></li>
</ul>

It has been proven by research that vitamin D can reduce your risk of developing cancer as well. Your chances of getting colorectal cancer decrease by 22% if your vitamin D is above the normal level, whereas the probability increases by 31% if the levels drop below normal.&nbsp; 
&nbsp;

Another study reveals that the higher the levels of vitamin D, the lower the risk of breast cancer<a href="#accordion">[5]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Manages Depression</h5>
	</li>
</ul>

Scientists have also seen that people <a href="https://merisehat.pk/disease/depression" target="_blank">suffering from depression</a> had low levels of vitamin D in their blood, and people with normal levels of vitamin D reported less of depression, implying that there may be a direct relation between the two. 
&nbsp;

<ul>
	<li>
	<h5>Improves Bone Health</h5>
	</li>
</ul>

Vitamin D is crucial to ensure your bone health. If a child lacks the optimum levels of vitamin D, he or she can develop rickets, which forces the bones to bend and give a bow-legged appearance. In adults, the variant is called osteomalacia, which leads to softening of the bone and muscular weakness as well<a href="#accordion">[5]</a>.&nbsp;

<ul>
	<li>
	<h5>Additional Benefits</h5>
	</li>
</ul>

Scientists now believe that basking in sunlight in order to synthesise vitamin D exposes one to the ultraviolet rays that help in preventing multiple sclerosis and Parkinson&rsquo;s disease<a href="#accordion">[5]</a>.

&nbsp;

A study done in 2017 had established that regulating vitamin D in the body prevents acute respiratory diseases.&nbsp; 
&nbsp;

Along with the fact that vitamin D boosts the antimicrobial peptide production, vitamin D is &ldquo;the&rdquo; talk of the town to help fight against COVID-19 as well. Researchers showed that 40% of the US population was deficient in Vitamin D, and was among those who readily contracted the viral disease. Hence, to put the theoretical knowledge to test, a study was conducted in which it was concluded that if you are vitamin D deficient, your chances of getting COVID-19 are 1.77 times higher<a href="#accordion">[6]</a>.&nbsp;&nbsp;

&nbsp;

Even though vitamin D seems like the most hyped about vitamin, it is still underrated. This has to do with the fact that deficiency related diseases are commonly dealt with prescribed supplementation. Vitamin D deficiency needs to be taken more seriously, as it can lead to extreme conditions ranging from weak bones to weak immunity. Hence, if you want to make sure that you are able to walk and are resistant to a number of sicknesses, get your vitamin D levels checked today!

<ul><li>The recommended daily allowance (RDA) of vitamin D is 15 mcg per day (600 IU) for adults who are 19 years old and above.</li><li>&nbsp;For adults over 70 years, it bumps up to 20 mcg daily (800 IU).</li><li>Vitamin D that comes from the skin or diet is in its inactive form, and requires a 2-step process before it can be used by the body.</li><li>First hydroxylation takes place in the liver; the second takes place in the kidneys, assisted by enzymes vitamin D-25-hydroxylase (25-OHase) and 25(OH)D-1-OHase (CYP27B1) respectively.</li><li>Vitamin D also initiates the absorption of calcium in the small intestine.</li><li>There are 3 categories of deficiency: mild, moderate, and severe.</li><li>Studies prove that 1 billion people in the world suffer from vitamin D deficiency or insufficiency.</li><li>A report presented by the National Health and Nutrition Examination Survey III (NHANES III) shows that 1% of individuals in the US suffered from vitamin D deficiency whereas 58% had insufficiency.</li><li>A study carried out in the South Asian region concluded that the prevalence rate of vitamin D was highest in Pakistan - around 63%-85%.</li><li>The major source for obtaining vitamin D is sunlight.</li><li>Use a sunscreen with a protection factor (PF) of 30 when going out in the sun.</li><li>Studies hypothesise that older people are less prone to get VDD because they usually take supplementation; hence, bridging the gap.</li><li>Vitamin D is a natural antagonist of the cardiac colony-forming unit fibroblasts (cCFU-Fs) and stops them from forming a scar. Thus, ensuring efficiency of the heart.</li><li>Studies support that your chances of getting colorectal cancer decreases by 22% if your levels are above normal, whereas the probability increases by 31% if the levels drop below normal.</li><li>People with normal levels of vitamin D have reported less depression.</li><li>Vitamin D is crucial to your bone health, as a deficiency can cause rickets in children and osteomalacia in adults.</li><li>Your chances of getting COVID-19 are 1.77 times higher if you are deficient in vitamin D.</li></ul>

[1] Nair, Rathish, and Arun Maseeh. “Vitamin D: The "sunshine" vitamin.” Journal of pharmacology & pharmacotherapeutics vol. 3,2 (2012): 118-26. doi:10.4103/0976-500X.95506

[2] Vitamin D. The Nutrition Source

[3] Hovsepian, Silva et al. “Prevalence of vitamin D deficiency among adult population of Isfahan City, Iran.” Journal of health, population, and nutrition vol. 29,2 (2011): 149-55. doi:10.3329/jhpn.v29i2.7857

[4] Siddiqee, M.H., Bhattacharjee, B., Siddiqi, U.R. et al. High prevalence of vitamin D deficiency among the South Asian adults: a systematic review and meta-analysis. BMC Public Health 21, 1823 (2021).