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MODULE 3

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EXERCISE BEHAVIOURS

The benefits of physical activity and healthy eating behaviours for physical and mental health are well documented. Physical activity is any activity that will get your body moving, increase your heart rate and breathing. It is not only restricted to structured exercise, for instance at a gym, or participating in team sport, but also includes activities such as walking to and from the bus stop, walking up and down stairs etc.

The opposite, sedentary behaviour, is when you are sitting or lying down (not including sleeping). In today’s society, many jobs are sedentary in their nature and many people also spend much time commuting to and from work. It is now believed that our often sedentary lifestyle is the second biggest contributor to the cancer burden in Australia. In addition, sedentary behaviours have been identified as a risk factor for a range of health conditions, including cardiovascular disease, diabetes and osteoporosis, as well as being a strong contributor to levels of obesity.

The current recommendation is to minimise the time spent in sedentary behaviour in order to enhance health and well-being. In this module we will outline the benefits of physical activity, but also what is regarded as healthy and unhealthy exercise behaviours.

Sources: Global Health Risks: Mortality and burden of disease attributable to selected major risks. World Health Organization, 2009

Your Physical Activity – How, What, When and Why?

Let’s take a look at what your physical activity profile looks like.

Click on the table below to download a PDF. Complete the table giving as much information as possible.


3.1 Benefits of Physical Activity

The department of health has published guidelines for recommendations of physical activity levels and dietary requirements for various ages. On average, it is recommended that 18-65 years olds participate in 2.5- 5 hours of moderate activity per week or 1.25- 2.5 hours of vigorous activity per week. Being physically active and limiting your sedentary behaviour every day is essential for your health and wellbeing.

In a study 2011-2012 it was shown that only 43% of adults met the recommended levels of physical activity.

http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/D4495467B7F7EB01CA257BAC0015F593?opendocument

There are several benefits of being physically active, of some benefits are outlined below:

  • Cardiovascular disease: helps reducing the risk, or help manage
  • Type 2 diabetes: helps reducing the risk, or help manage
  • Cholesterol levels: maintain and/or improve
  • Blood pressure: maintain and/or improve
  • Blood sugar levels: helps maintain and/or improve
  • Some cancers: helps reduce your risk, and assist with rehabilitation
  • Weight gain: helps prevent
  • Weight loss: assists with
  • Bone density: helps maintain and/or improve
  • Social health: helps socialising and meet new people
  • Mental health: helps prevent and manage
  • Physical and mental well-being: helps to develop and maintain

It is worth including a special mention of the health benefits of resistance training. A lot of people, women in particular, avoid resistance training in the fear of ‘getting bulky’ or gaining weight. However, this fear is unjustified as resistance training is beneficial for both physical and mental health. It is recommended to train each major muscle group twice a week.

Some of the benefits of resistance training include:

  • Muscle strength and tone: helps improve and/or maintain
  • Joints: helps to protect from injury
  • Flexibility and balance: helps maintain and/or improve
  • Weight management and improved muscle-to-fat ratio: helps improving body composition
  • Cognition: helps prevent or reduce cognitive decline as you get older
  • Diabetes: helps prevent or control
  • Cardiovascular disease: helps prevent or control
  • Arthritis: helps prevent or control
  • Bone density: helps maintain and/or improve
  • Back pain: helps prevent or control
  • Depression: helps boost mood and manage signs of depression
  • Pain management
  • Posture: helps improve
  • Mobility and balance: helps improve or maintain
  • Well-being: helps improve self-confidence, self-esteem, body image
  • Sleep: helps improve sleep and avoidance of insomnia

Links to the following for further reading:

http://www.smh.com.au/national/health/concerning-number-of-women-suffering-depression-anxietystudy-20170827-gy4z76.html

https://training.nutritionwarehouse.com.au/training-as-you-age

https://lifestyle.nutritionwarehouse.com.au/body-image-self-image-and-weight-training


3.2 What is excessive exercise?

There are numerous health benefits from being more active and less sedentary. However, people often believe that more is better in regards to training, but this is not true. So when does the level of physical activity become unhealthy? How do you get the beneficial psychological and physical benefits of physical activity without forming dysfunctional and excessive exercise behaviours?

There are three terms to define and consider:

1. Overtraining occurs when the body cannot keep up with the physiological demand of the exercise, having negative consequences on many physiological systems. Overtraining can often lead to exercise dependence.

2. Exercise dependence occurs when a person becomes addicted to exercise, training multiple times a day and can experience withdrawal.

3. Excessive exercise has diagnostic criteria in the DSM IV (The Diagnostic and Statistical Manual of Mental Disorders – 4th Ed). These are exercises that:

  • Significantly interferes with important activities
  • Occurs at inappropriate times or in inappropriate settings
  • Continues despite injury or other medical complications

When considering eating disorders, the exercise behaviours that need to be considered are the amount of exercise, whether the exercise is whether the exercise is considered by the individual as compulsory and what their motivation for exercise is. When the motivation for exercise is purely to influence body weight or shape and this exercise is seen as mandatory, extreme guilt and anxiety is experienced. These elevated levels of anxiety are predictors of eating disorders and can lead to impaired quality of life. I believe that the dangerous part of excessive exercise and any rigid diet behaviour, is when a person’s sense of worth is dependent on adhering to the strict regimes.

A professional athlete may train and compete for double or triple the time recommended in the guidelines for physical activity. Does this constitute excessive exercise? They may eat appropriate amounts of all the food groups to fuel their bodies for this level of participation.

Ask yourself the following questions and answer on a scale of importance 1 (never) – 10 (always)

1. How important do you think it is to not miss your exercise session in relation to your health?
2. Do you get upset if you are unable to exercise?
3. Do you try to make up time for one or more exercise sessions that are missed?
4. Do you exercise at the same time of day, the same exercise regime, the same location, the same intensity and same time spent exercising?
5. Do you exercise despite feeling tired or unwell?
6. Do you exercise despite having an injury?
7. Do you feel like a failure if you miss an exercise session?
8. Do you turn down social invitations if it interferes with your exercise session?

Exercise is deemed to be excessive when its postponement is accompanied by intense guilt or when it is undertaken solely to influence weight or shape (Mond et al., 2006).


3.3 Exercise habits

Commented [3]: I would like this as an activity where the
participants first categorise the open circle bullet points
as healthy or unhealthy. (maybe drag and drop) I think
this will show us what behaviours each individual
actually believes is healthy (but is actually not) THEN
after they have done this, our list of healthy and
unhealthy for their comparison. From our list they then
subcategorise by drag and drop under the red headings

3.3.1 Healthy exercise habits

What do healthy exercise habits look like?

1) Rest and recovery

  • Allowing adequate rest for muscle repair and recovery
  • Allowing rest when sick, injured or tired

2) Flexibility

  • Incorporating some form of flexibility training to ensure proper range of motion

3) Balance

  • Incorporating some form of balance training

4) Strength and power

  • Incorporating strength and resistance training at least 2 days per week

5)Performance

  • Focus on performance and progression

6) Behaviours

  • Not favouring one particular mode of exercise
  • Not feeling anxious and guilty if missing a workout/session
  • Exercise for enjoyment

3.5.2 Unhealthy exercise habits

1) Lack of rest and recovery time

  • Training while sick
  • Training while injured
  • Not allowing adequate rest for muscle repair and recovery
  • Exercise through pain
  • Engage in extended bouts of exercise of any kind (more than 60min) multiple times a day.
  • Experience anxiety related to inability to exercise

2) Rigid exercise behaviours

  • Sticking to rigid plans concerning type of exercise and the amount of time spent on this activity. Not allowing for changes in routine or for rest days
  • Not incorporating some form of flexibility training to ensure proper range of motion

3) Lack of Balance

  • No balance between exercise routine and other life activities/commitments
  • Not incorporating some form of balance training
  • Believe that exercise takes precedent over other life activities

4) Strength and power

  • Not incorporating strength and resistance training at least 2 days per week
  • Decreased immunity

5) Unhealthy Motivation

  • Focus on exercise to burn calories rather than on performance

6) Unhealthy Thoughts and Behaviours

  • Exercise as a means of punishment or control
  • Feeling guilty if missing a workout/session
  • Not allow time to recover sufficiently causing poor performance, frequent illness, disturbed sleep and alterations in mood.
  • Engage in guilt driven exercise without enjoyment
  • Label yourself as a failure if you break an exercise regime
  • Use exercise as a reason to eat
  • Have an addiction or compulsion to exercise, including in private
  • Feel the compulsion to exercise more
  • Have a compulsion to perform cardiovascular exercise.

7) Other

  • Have menstrual dysfunction due to excessive exercise and diet habits
  • Engage in deliberate behaviour to maximize energy expenditure
  • Use competitive sport as an excuse for extreme exercise regimes

Activity

Click on the table below to download the PDF. For each of the unhealthy behaviours, put a tick for which aspect(s) of health are affected.

1. Adams, Jeremy, and Robert Kirkby. “Exercise dependence and overtraining: The physiological and psychological consequences of excessive exercise.” Sports Medicine, training and rehabilitation 10.3 (2001): 199-222.

2. Mond, Jonathan M., et al. “An update on the definition of “excessive exercise” in eating disorders research.” International Journal of Eating Disorders 39.2 (2006): 147-153.


3.3 Relative Energy Deficiency in Sport

Relative Energy Deficiency in Sport or RED-S was previously referred to the female athlete triad. Since changing the name to RED-S, additional physiological and psychological components have been added and refers to males also. The negative effects of RED-S occurs when there is an imbalance between energy intake and energy output, that is, the energy intake does not match the energy need as required by the amount of exercise performed. This syndrome is of a health concern due to the negative effects associated with the relative energy deficiency.

3.3.1 Health consequences of RED-S

As mentioned above, RED-S is associated with several negative health consequences, and it is important to be able to recognise and identify these as a sign of relative energy deficiency.

Include image of body and have dots on the organ systems that are negatively affected. Once they click the dot, the negative effect will show up.

Hematological
– reduced VO2 Max
– reduced hemoglobin

Metabolic

– reduced metabolism

Endocrine

– over training can lead to decrease in testosterone levels and increase in cortisol levels. This imbalance can contribute to stress fractures and joint injury.
– Impaired function of hypothalamus and pituitary gland results in impaired ovarian function

Bone health*

Menstrual function*

Immunological – increased risk of infection

Gastrointestinal

Cardiovascular
– accelerated heart rate
– increased blood pressure even at rest.

Psychological
– irritability
– emotional instability
– restlessness
– easily distracted
– depression
– lower self esteem
– increased sensitivity to stress
– increased anxiety

Growth and development

*part of the female triad


3.3.2 Performance consequences of RED-S

In addition to negative health consequences, there are also potential negative impacts on performance, such as:

  • Decreased muscle strength
  • Decreased endurance performance(aerobic and anaerobic)
  • Increased injury risk
  • Decreased training response
  • Impaired judgement
  • Decreased coordination
  • Decreased concentration
  • Decreased glycogen stores

http://www.eatright.org/resource/fitness/sports-and-performance/tips-for-athletes/preventingrelative-energy-deficiency-in-young-female-athletes

https://uncexchanges.org/2017/04/06/what-is-relative-energy-deficiency-in-sport-red-s/http://bjsm.bmj.com/content/48/7/491.long


3.4 Training and the menstrual cycle

On a monthly basis females experience a fluctuation of different hormones as part of their menstrual cycle. The length of the cycle varies from woman to woman and is normally anywhere between 21 and 35 days and may last from 2 – 7 days. For the purpose of this discussion, we will have the cycle as being 28 days.

The monthly cycle is comprised of two distinct phases, the follicular phase and the luteal phase.

 

The first phase of the cycle is referred to as the follicular phase. This phase starts the first day of menses. The first 5 days of the follicular phase, when menses occur and the uterus shed its inner lining, is also called the menstrual phase. The follicular phase ends at ovulation, which
normally around day 14 of the cycle. During the follicular phase, the levels of estrogen increases in order to stimulate follicle growth and ripening.

During the second phase, the luteal phase, which starts the day after you ovulate, progesterone levels increases before decreasing to prepare for menses again. During this phase there is also a slight increase in estrogen, which also decreases to prepare for menses and to start the cycle again.

Although these hormones have a reproductive function, they also have an impact on fuel storage and fuel use (carbohydrates vs. fat) with receptors found all over the body, including muscle and fat tissue. One of the most noticeable effects is the effect they have on hunger,
energy and cravings through their effect on cortisol, insulin, serotonin, GABA and dopamine.

The follicular phase seems to be the time of the month

During the follicular phase the body shifts into fat storing and burning carbohydrates, with increased cravings.

During the follicular phase the egg is not yet released, but after ovulation the possibility of an egg being fertilized means the body shifts into more of fat storing, craving physiology and becomes more reliant on sugar burning (more insulin resistant) which would provide easily accessible fuel for a growing fetus.

So, very simply, the follicular phase is a time of relatively better fat burning, while the luteal phase shifts the body into more relative use from sugar versus fat. Estrogen directly opposes the action of insulin on the major fat storing enzyme LPL, essentially making the body less prone to fat storage and more prone to fat release.

Estrogen is also anti-cortisol (as is progesterone). This means women may be able to better tolerate a little more starch and burn greater
proportions of fat during exercise with less consequences of stress hormone production. This is a great time to focus more on an eat more, exercise more strategy.

https://www.metaboliceffect.com/female-phase-training-training-with-the-menstrualcycle/

Missed period or loss of cycle – what’s the big deal?

Over exercising and/ or restricted eating can cause a female’s menstrual cycle to become irregular or cease all together. This is known as amenorrhea and is caused due to a drop in estrogen levels. This in turn effects bone density and can lead to osteoporosis, as bones become brittle. If this occurs at a young age, this can affect posture, performance and development of stress fractures. The ability to train is
reduced with increased risk of injury.

Estrogen is also responsible for:

  • Assisting nutrient assimilation
  • Regulating body weight
  • The metabolism of glucose
  • Maintaining the body’s sensitivity to insulin

As well as the loss of the menstrual cycle and bone density, low levels of estrogen can result in:

  • Low vaginal lubrication causing painful sex
  • A thinning of the lining of the urinary tract increasing risk of infection
  • Mood swings
  • Hot Flushes
  • Insomnia
  • Depression
  • Lower concentration levels
  • Breast tenderness
  • Headaches
  • Fatigue
  • Infertility

From this module, it is evident that although a certain level of physical activity is required for our health, there are many negative physiological and psychological consequences from overtraining and excessive exercise. These are NOT healthy.

It may be a sad projection of a society that can often promote poor coping strategies, where individuals can fail to manage negative emotions, have low self-esteem and where HEALTH is interpreted by body shape without regard of physical, mental and emotional health.

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