Guidelines for exercising in heat and humidity have been developed for road races, but these can be applied to any strenuous physical activity performed outdoors during warm weather. Ambient conditions are considered safe when the temperature is below 70° F and the humidity is below 60%. Caution should be used when the temperature is greater than 80° F or the humidity is over 60%. People who are sensitive to heat and humidity should reconsider exercising when the temperature is greater than 80° F or the humidity is more than 60%. People who are trained and heat acclimated can continue to exercise in these conditions, but they should be aware of the potential hazards and take precautions to prevent heat illness.

The keys to exercising without incident in hot weather are to acclimate to the heat and maintain the body’s normal fluid level. The major consequence of dehydration (excessive fluid loss) is a reduction in blood volume. This results in sluggish circulation that decreases the delivery of oxygen to the exercising muscles. second, lowered blood volume results in less blood that can be sent to the skin to remove the heat generated by exercise. If too much of the blood volume is lost, sweating will stop and the body temperature will rise, leading to heat-stress illness. Heat illness is a serious problem that can be avoided by following a few guidelines designed to preserve the body’s fluid level.

Preexercise fluid ingestion drink 12 to 20 ounces of a noncarbonated, lightly salted liquid 15 to 30 minutes before exercising. You can purchase commercially prepared sports drinks, such as Gatorade, 10-K, All Sport, and so on, or mix a teaspoon of salt in a gallon of lemonade. Water is not the best liquid source because it stimulates the production of urine, leaving less liquid for sweating.

Fluid replacement during exercise. The primary reasons for drinking during exercise are to maintain body water stores so that sweating can continue and to maintain blood volume.

Water is the preferred drink when exercise lasts less than 2 hours. Water exits the stomach rapidly and moves to the tissues that need it.

Urine production is not a problem during exercise because fluid is used to produce sweat.

A noncarbonated beverage containing salt and sugar is preferred if exercise lasts longer than 2 hours (for example, during marathons, long distance cycling, and ultra distance running events and triathalons).

You should drink 6 to 8 ounces every 15 minutes during exercise.

Postexercise fluid replacement

Plain water is a poor drink during recovery from exercise because it suppresses the thirst drive, so fluid intake stops before rehydration is complete.

Carbonated drinks are filling, prematurely blunt the thirst drive, and do not effectively contribute to recovery.

You should avoid alcoholic beverages and caffeinated beverages because these stimulate urine production. All ingested fluids need to be retained for the purpose of rehydration.

You should drink fluids that contain salt and sugar. Again commercial sports drinks are appropriate. In addition, they taste good, which encourages exercisers to drink more. This counteracts the tendency of most people to drink less than they need if water is the alternative.

Estimating water loss

Weigh yourself nude before and after exercise.

Towel off sweat completely after exercise and then weigh yourself.

Each pound of weight loss represents about 1 pint of fluid loss. Be sure to drink that and more after exercise.

Modify the exercise program by

Working out during cooler times of day.

Choosing shady routes where water is available.

Slowing the pace and/or shortening the duration of exercise on particularly oppressive days.

Wearing light, loose, porous clothing to facilitate the evaporation of sweat.

Other considerations

Never take salt tablets. They are stomach irritants, they attract fluid to the gut, they sometimes pass through the digestive system undissolved, and they may perforate the stomach lining.

Exercise must be prolonged, produce profuse sweating, and occur over a number of consecutive days to reduce potassium stores. For the average bout of exercise, you do not need to worry about depleting potassium or make a special effort to replace it. The daily consumption of fresh fruits and vegetables, as suggested by the new food pyramid, is all that is needed.

Remember to use a sunscreen lotion when the weather is sunny or hazy. Be sure that the sunscreen you select has a “sun protection factor” (SPF) of at least 15, and apply it liberally over exposed skin.

Human beings work and exercise in a variety of environmental conditions. Hot and cold weather produce unique problems for people who function outdoors. Their safety and comfort depend on their knowledge of the ways the body reacts to physical activity in different climatic conditions.

Heat is produced in the body as a by product of metabolism. Physical activities significantly increase metabolism, so more heat than normal is generated. Heat must be dissipated effectively, or heat build up (hyperthermia) may result in illness and possible death. Hyperthermia is abnormally high body temperature. Heat exhaustion is a serious condition but not an imminent threat to life. It is characterized by dizziness, fainting, rapid pulse, and cool skin. Treatment includes immediate cessation of activity and moving to a cool, shady place. The Victim is placed in a reclining position and given cool fluids to drink.

Heat stroke is a medical emergency and a threat to life. It is the most severe of the heat induced illnesses. The symptoms include a high temperature (106° F or above) and dry skin caused by cessation of sweating. These symptoms are accompanied by some or all of the following: delirium, convulsions, and loss of consciousness. The early warning signs include chills, nausea, headache, and general weakness. Victims of heat stroke should be rushed immediately to the nearest hospital for treatment.

Guidelines For Exercise In The Cold

Problems related to exercise in cold weather include frostbite and hypothermia (abnormally low body temperature). Frostbite can lead to permanent damage or loss of a body part from gangrene. This can be prevented by adequately protecting exposed areas, such as fingers, the nose, ears, facial skin, and toes. Gloves, preferably mittens or thick socks, should be worn to protect the fingers, hands, and wrists. A stocking hat is preferable for two reasons:

Blood vessels in the scalp do not constrict effectively, so a significant amount of heat is lost if a head covering is not worn.

A stocking type hat can be pulled down to protect the ears.

In very cold or windy weather, you can use surgical or ski masks and scarves to keep facial skin warm and to moisten and warm inhaled air. All exposed or poorly protected flesh is vulnerable to frostbite when the temperature is low and the wind chill high. Air temperature plus wind speed equals the wind chill index. This value should be known if one is to dress appropriately for outdoor exercise. A temperature of 40°F with a wind speed of 15 mph produces a windchill index of 22°F, meaning that these two factors together make a temperature of 40°F feel like 22°F.

People often experience a hacking cough for a minute or two after physical exertion in cold weather. This is a normal response and should not cause alarm. Very cold, dry air may not be fully moistened when it is inhaled rapidly and in large volumes during exercise, so the lining of the throat dries out. When exercise is discontinued, the respiratory rate slows and the volume of inhaled air decreases, allowing enough time for the body to fully moisturize it. Coughing stops within a couple of minutes as the linings are remoistened.

Hypothermia is the most severe of the problems associated with outdoor activity in cold weather. Hypothermia occurs when body heat is lost faster than it can be produced. This can be a life threatening situation.

Exercise in cold weather requires insulating layers of clothing to preserve normal body heat. Without this protection, body heat is quickly lost because of the large temperature gradient between the skin and environment. In addition to the insulating qualities of layers of clothing, a layer or two can be discarded if you get too hot.

Hypothermia can occur even if the air temperature is above freezing. For instance, the rate of heat loss for any temperature is influenced by wind velocity. Wind velocity increases the amount of cold air molecules that come in contact with the skin. The more cold molecules, the more effective the heat loss. The speed of walking, jogging, or cycling into the wind must be added to the speed of the wind to properly evaluate the impact of wind chill.

You should wear enough clothing to stay warm but not so much that you induce profuse sweating. The amount of clothing appropriate is based on experience that comes from exercising in different environmental conditions. Clothing that becomes wet with sweat loses its insulating qualities. It becomes a conductor of heat, moving it from the body quickly and potentially endangering the exerciser.

If you exercise or work outdoors in cold weather, you may want to wear polypropylene undergarments. Polypropylene is designed to wisk perspiration away from the skin so that evaporative cooling will not rob heat from the body. You should wear a warm outer garment, preferably made of wool, over this material. If it is windy, you should wear a breathable windbreaker as the third, outer layer.

If you follow the guidelines for activity in hot and cold weather, you can usually participate quite comfortably all year long.

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What’s Good on the Menu?

While some restaurants do offer hints for health conscious diners, you’re on your own most of the time. you order wisely, here are lighter options and high-fat pitfalls. choices have fewer than 30 grams of fat, a generous meal’s worth for an active, medium-sized woman. choices have up to 100 grams of fat.

Fast Food

Best

Grilled chicken sandwich

Roast beef sandwich

Single hamburger

Salad with light vinaigrette.

Worst

Bacon burger

Double cheeseburger

French fries

Onion rings.

Tips

Order sandwiches without mayo or “special sauce.” Avoid deep-fried items like fish fillets, chicken nuggets, and French fries.

Italian

Best

Pasta with red or white clam

Spaghetti with marinara or tomato-and-meat sauce.

Worst

Eggplant parmigiana

Fettuccine alfredo

Fried calamari

Lasagna.

Tips Stick with plain bread instead of garlic bread made with butter or oil. Ask for the waiter’s help in avoiding cream- or egg-based sauces.

Chinese

Best

Hot-and-sour soup

Stir-fried vegetables

Shrimp with garlic sauce

Szechuan shrimp

Wonton soup

Worst

Crispy chicken

Kung pao chicken

Moo shu pork

Sweet-and-sour pork

Tips Share a stir-fry; help yourself to steamed rice. Ask for vegetables steamed or stir-fried with less oil. Order moo shu vegetables instead of pork. Avoid fried rice, breaded dishes, and items loaded with nuts.

Sandwiches

Best

Ham and Swiss cheese

Roast beef

Turkey

Worst

Tuna salad

Reuben

Submarine

Tips Ask for mustard; hold the mayo and cheese. See if turkey-hamis available.

Mexican

Best Bean burrito (no cheese)Chicken fajitas

Worst

Beef chimichanga

Chile relleno

Quesadilla

Refried beans

Tips Choose soft tortillas with freshsalsa, not guacamole. Special- order grilled shrimp, fish, or chicken. Ask for beans made without lard or fat.

Breakfast

Best

Hot or cold cereal with 2% milk

Pancakes or French toast with syrup

Scrambled eggs with hash browns and plain toast

Worst

Belgian waffle with sausage

Sausage and eggs with biscuits and gravy

Ham and cheese omelette with hash browns and toast

Tips Ask for whole-grain cereal or shredded wheat with 1 % milk or whole-wheat toast without butter or margarine. Order omelettes without cheese, fried eggs without bacon or sausage.

Seafood

Best

Broiled bass, halibut, or snapper

Grilled scallops

Steamed crab or lobster

Worst

Fried seafood platter

Blackened catfish

Tips Order fish broiled, baked, grilled, or steamed-not pan- fried or sauteed. Ask for lemon instead of tartar sauce. Avoid creamy and buttery sauces.

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Taxonomic class

Apiaceae

Common Trade Names

Dong Kwai, Dong Quai Capsules, Dong Quai Fluid Extract

Common Forms

Raw root: 4.5 to 30 g (boil or soak in wine)

Tablet (fluidextract): 0.5 g

Also available as capsules, powders, teas and, in some countries, injectable forms.

Source

Active components are obtained from the roots of dong quai (Angelica polymorpha var. sinensis), a fragrant perennial umbelliferous herb that is native to China, Korea, and Japan.

Chemical Components

The volatile oils extracted from the root contain n-butylphthalide, cadinene, carvacrol, dihydrophthalmic anhydride, folinic acid, isosafrole, ligustilide, nicotinic acid, safrole, succinic acid, uracil, and vitamin B12. Coumarin derivatives identified in dong quai include bergapten, imperatorin, osthole, oxypeucedanin, and psoralen. Ferulic acid has also been found.

Actions

Dong quai alters uterine activity in female rabbits. The volatile oil has an inhibitory action on the uterus, whereas the nonvolatile and water-and alcohol-soluble components have stimulatory action.

Studies conducted in rats showed increases in metabolism, oxygen use by the liver, and glutamic acid and cysteine oxidation; these actions may be attributed to vitamin B12 and folinic acid that occur in the herb’s root.

Dong quai extracts, especially alcoholic extracts, were also found to exert quinidine-type effects, prolong the refractory period, and correct atrial fibrillation in animals. Other studies in rats showed that these extracts may prevent atherosclerosis, expand coronary arteries, and increase coronary blood flow. Some coumarins are known to act as vasodilators. Although studies in animals have shown that the volatile oil exerts vasodilatory action to lower blood pressure, the duration of action is short.

Reported Uses

Dong quai is recommended by Western herbalists for many gynecologic disorders, including dysmenorrhea, excessive fetal movement, menstrual irregularities, chronic pelvic infection, and premenstrual syndrome. Most claims are based on data from animal studies or small, uncontrolled human trials, but in a double-blind, placebo-controlled trial of 71 postmenopausal women, dong quai alone was found not to produce estrogen-like responses in endometrial thickness or vaginal maturation and not to be useful in managing postmenopausal symptoms . In traditional Chinese medicine, dong quai is used in combination with other herbs to relieve dysmenorrhea and other disorders. Kotani and colleagues evaluated such an herbal preparation including dong quai in 41 women with dysmenorrhea and found it effective in diminishing symptoms. Because an NSAID was allowed on an as- needed basis, it is difficult to determine the effect of the herbal preparation. Other reported uses include treatment of Buerger’s disease, constipation, headache, hepatitis, hepatocirrhosis, herpes zoster, hypertension, malaria, neuralgia, pyogenic infection, Raynaud’s disease, chronic rhinitis, sepsis, toothache, and ulcerous diseases or abscess. None of these uses has been evaluated clinically.

Dosage

Dosage forms, strengths, and extraction forms vary. In a placebo­controlled study evaluating the estrogenic effects of dong quai on endometrial thickness in postmenopausal women, 500-mg capsules taken P.O. t.i.d. (equivalent to 0.5 mg/kg of ferulic acid), for a total daily dose 4.5 g of root, were used.

Adverse Reactions

GI: diarrhea.

Hematologic: bleeding.

Skin: increased photosensitivity (psoralens in herb may cause severe photodermatitis) .

Other: fever.

Interactions

Anticoagulants, antiplatelets: May enhance effects. Avoid administration with dong quai.

Contraindications And Precautions

Safrole, a component of the volatile oil, is carcinogenic and not recommended for ingestion. Dong quai is contraindicated in pregnant or breast-feeding patients because its chemical components may cause fetal harm. Traditional Chinese texts advise against using dong quai in the presence of an acute infection.

Special Considerations

Monitor the patient for potential bleeding.

Ask why the patient is using dong quai and suggest that he seek a health care provider to address these concerns.

Caution the patient that some of the herb’s components have been shown to increase the risk of some cancers.

Instruct the patient who becomes photosensitive to use sunblock and to wear adequate clothing and sunglasses.

Caution the patient against using dong quai for its yet unproven estrogenic effects.

Advise women to report planned or suspected pregnancy and to avoid using this herb during pregnancy or when breast-feeding.

Commentary

Despite numerous therapeutic claims for dong quai, only a few controlled clinical trials and animal-based studies are available to support its use to treat dysmenorrhea. Most claims regarding dong quai are unsubstantiated and need additional investigation. Dong quai appears to have more than 18 active chemical components, many of which exert widely divergent pharmacologic effects. Some components are carcinogens, and adverse effects of others are unknown. Extensive testing of individual components is needed before dong quai can be regarded as safe or effective.

Taxonomic class

Asteraceae

Common Trade Names

Feverfew, Feverfew Glyc, Feverfew Power, Tanacet

Common Forms

Available as capsules (pure leaf, 380 mg; leaf extract, 250 mg), liquid, and tablets. The leaves are commonly used to make infusions or teas.

Source

Feverfew, a plant from Europe naturalized in the United States and Canada, bears yellow-green leaves and yellow flowers from July to October. The leaves of the plant are usually dried or used fresh in teas and extracts. The most commonly cited botanical name is Chrysanthemum parthenium, synonymous with Tanacetum parthenium. Matricaria parthenium, Leucanthemum parthenium, and Pyrethrum parthenium are also used to refer to the plant.

Chemical Components

The leaves and flowering tops of feverfew contain many monoquiterpenes and sesquiterpenes as well as sesquiterpene lactones (chrysanthemolide, chrysanthemonin, 10-epi-canin, magnoliolide, and parthenolide), reynosin, santamarin, tanaparthins, and other compounds. Parthenolide may be absent or occur in variable amounts, depending on geographic and other variables. Interestingly, melatonin has been found in significant quantities in both the feverfew plant and commercial feverfew products. Fresh green feverfew leaf contains 2.45 mcg/g of melatonin, whereas the freeze-dried leaf contains 1.61 mcg/g of melatonin .

Actions

The main active ingredients are the sesquiterpene lactones, particularly parthenolide, which inhibits serotonin release by human platelets in vitro. This may be the mechanism of action for feverfew’s purported efficacy in treating migraine headaches . Parthenolide also inhibits serotonin release and has demonstrated significant cytostatic activity toward mouse fibrosarcoma (MN-1 1) and human lymphoma . Extracts of feverfew contain several chemicals that inhibit activation of polymorphonuclear leukocytes and the synthesis of prostaglandins and leukotrienes (by way of inhibition of the cyclooxygenase and 5-lipoxygenase pathways). In murine studies, anti-inflammatory and antinociceptive effects have been documented for both feverfew extract and parthenolide.

Reported uses

Although the initial enthusiasm for feverfew has waned, plant preparations are again becoming increasingly popular for use in migraine prophylaxis and as an antipyretic. A detailed and systematic review of all trials of feverfew for migraine prevention published before mid-1998 failed to find sufficient evidence to support the use of feverfew in this regard.

Feverfew is also claimed to be useful for treating asthma, insect bites, menstrual problems, threatened miscarriage, psoriasis, rheumatism, stomachache, and toothache. These uses have not been assessed in human trials.

Dosage

For migraine prophylaxis, 25 mg of freeze-dried leaf extract P.O. daily; 50 mg of leaf P.O. daily with food; or 50 to 200 mg of aerial parts of plant P.O. daily.

For migraine treatment, average dose of 543 mcg P.O. parthenolide daily.

Adverse Reactions

EENT: mouth ulcers (common with teas and whole-herb preparations).

Other: hypersensitivity reactions, post-feverfew syndrome (withdrawal syndrome characterized by moderate to severe pain, joint and muscle stiffness, and anxiety).

Interactions

None reported.

Contraindications And Precautions

Feverfew is contraindicated in pregnant or breast-feeding women.

Special considerations

Monitor for allergic reaction.

Monitor for mouth ulcers. Encourage the patient to exercise proper oral hygiene.

Feverfew potency is often based on the parthenolide content in the preparation, which is variable.

Instruct the patient not to withdraw the herb abruptly but to taper its use gradually because of the risk of post-feverfew syndrome.

Inform the patient that several other strategies for migraine treatment and prophylaxis exist and that they should be attempted before taking products with unknown benefits and risks.

Encourage the patient to promptly report unusual symptoms, such as mouth sores and skin ulcerations.

Commercial feverfew products are likely to contain small amounts of melatonin.

Points of Interest

The concentration of parthenolide in the leaves and flowering tops is highest during the summer, before the seeds are set, and drops rapidly thereafter. This has been offered as an explanation for the difference in parthenolide levels between brands of feverfew capsules and tablets.

The Health Protection Branch of the Canadian government has proposed a standard that formulations contain a minimum of 0.2% parthenolide.

Commentary

Although feverfew has been shown to be effective for migraine prophylaxis in at least two clinical trials, further studies are needed to define better dosage guidelines and specific drug interactions and mechanisms of action. For patients in whom standard drug therapy has failed, feverfew may be an agent that can prevent migraine attacks. Although standardized feverfew preparations with dosages based on free parthenolide content have the best experimental support, no consensus on use exists. The presence of melatonin in feverfew and other botanicals emphasizes the need for complete biochemical characterization of herbal medicinals.

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