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Wild salmon parasite warning

Food safety advice for anglers and other fishing enthusiasts who may want to eat their own catch of Atlantic salmon and sea trout.

Atlantic salmon and sea trout caught at sea or in UK rivers are known to be at risk of being infected with a parasitic worm called anisakis.

Parasites in fish, particularly anisakis, can cause serious health problems if eaten alive, including acute gastrointestinal symptoms and severe allergic reaction.

The Food Standards Agency has issued the following advice for anyone eating wild Atlantic salmon or sea trout privately caught at sea or from UK rivers:

Remove the guts

Remove the guts and then visually inspect the fish body cavity and muscle walls to detect and remove all visible parasites.

Anisakis worms may be seen on the surfaces of tissues around the gut. Worms are colourless and normally coiled like a spring within a cyst. Worms range in size from 5mm-20mm.

In most cases, especially in salmon, they may also be found within the muscles, especially in those that surround the body cavity and the anus. It’s important to check the muscle surrounding the anus, particularly if the fish have red and swollen vents.

Freeze before eating

If wild fish are to be eaten raw or lightly cooked, all parts should be frozen at -15C or colder for at least four days in a domestic freezer. This will ensure that any undetected parasites are destroyed.

This freezing advice also relates to wild caught fish that are to be cold smoked or eaten after marinating or salting.

Cook thoroughly

Where wild caught fish are to be hot smoked (at a core temperature above 60C), the flesh of the fish should be steaming hot throughout after smoking and generally have a flaky texture. This cooking process will kill any parasites present, and make the fish safe to eat without freezing first.

Where it is not possible to freeze the fish properly, cook the fish at a temperature of 70C for two minutes to kill any parasites present. 

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Life after cancer

Beating cancer can be physically and emotionally tough, and sometimes the journey doesn't end when you get the all-clear. For many people, adjusting to life beyond cancer can be difficult, with a new set of challenges to face.

I've been given the all-clear. Why do I feel so down?

There is no right or wrong way to feel. Everyone's experience of surviving cancer will feel slightly different  it depends on your personality, personal circumstances and what type of cancer and treatment you have had. But for most people it's an emotional experience. 

Some people feel able to resume their life easily when their cancer treatment finishes and can put the experience behind them. Some are so pleased to have survived cancer that they relish their cancer-free life with renewed vigour. But for many others, the physical and emotional impact of their cancer experience hits home when it's all over. In fact, 40% of people who've experienced cancer report a significant level of anxiety or depression following the completion of treatment.

According to Dr Frances Goodhart, consultant clinical psychologist and author of 'The Cancer Survivor's Companion', this is a very natural response.

"When you find out you have cancer, it can all happen very quickly  the diagnosis followed by treatment decisions within days  and then you often go through a gruelling time getting through the treatments with loved ones and healthcare professionals all around you, helping you through it. It's only afterwards, when your support team has gone and you have the time to think about what you've been through, that you feel the effects."

Common feelings and experiences after cancer

Your emotions

You may find that you are trying to cope with anxiety, low mood, depression, anger or a mixture of negative emotions.

There are many reasons why this might be the case. Dr Goodhart explains that, "It's very common to feel frightened or vulnerable, sad or angry because of what's happened to you. I've known patients to feel lost when their treatment is over and they're no longer getting support from their cancer care team, or lonely because friends and family can be wonderful but they don't always understand the trauma you've been through.

"Others are scared to be happy in case the cancer comes back, and it's also common to feel confused about how to fit back into your life because your role and your relationships have had to change during your treatment.

"On top of that, people often feel guilty about those feelings because their family and their doctors have worked so hard to get them to that point, and they feel terrible for not feeling as happy as everyone else that they've got through it. And so it's common to put on a front to protect friends and family, and they [cancer survivors] can end up feeling quite isolated.

"Some of these emotions do resolve over time, but time alone is not always the answer. A lot of the distress does fade into the background over time, but you may need to find ways to manage it in whatever way suits you."

For tips to help with feeling more positive, see 'Advice on coping after cancer' below.

Physical changes

You may also be dealing with some physical changes that have resulted from cancer or cancer treatment. Changes to your body might include hair loss, weight loss or gain, scarring, loss of a limb or breast, loss of sexual function, or having a colostomy bag.

Whether your body has changed in a way that is visible to others or not, it can be a lot to come to terms with and adapt to. Your body and your appearance can have a big impact on how you feel about yourself and how you think others perceive you. Your self-esteem may have taken quite a knock and this can affect your confidence in a number of ways for example at work, in social situations and in your relationships.

However, it is possible to come to terms with your body changes. Find more information below in 'Advice on coping after cancer'.

Fatigue

Cancer and cancer treatments can also leave you feeling fatigued (overwhelmingly tired). According to Dr Goodhart, "At least three-quarters of people going through cancer treatment say that they experience it, and the majority of those continue to feel fatigued after treatment ends."

Fatigue can be long-lasting and disrupt many areas of your life, so it's important not to ignore it. Instead, listen to your body and give yourself time to adjust. Dr Goodhart recommends trying the "3 Ps" prioritise, plan and pace yourself as a way of coping until the fatigue starts to lift. Try making a plan each day, prioritising the most important things you would like to achieve, and stick to it. If you find certain tasks take it out of you, pace yourself by reducing the amount you do.

At the same time, being physically active can help to reduce your fatigue, if you go about it in the right way. Start with a small amount of physical activity and gradually increase it over time. Don't do more than you feel able to. The type of exercise you choose can also be important. For more information, read Macmillan's advice about exercise after cancer treatment.

Read more self-help tips on fighting fatigue.

Advice on coping after cancer

Talking and support

Not everyone likes to talk about their feelings or how difficult they're finding a situation. If this is you, don't feel obliged to open up. You may find that working through the hard times by yourself or expressing yourself more privately through art or music works best for you.

But for many of us, talking to someone about a distressing experience provides an opportunity to let off steam, let out difficult feelings, receive support and get a different perspective on things.

Who you talk to depends on your circumstances and how you're feeling. Some people are most comfortable with their partner or a close family member, while others find it hard to admit their true feelings and worries to their loved ones.

Dr Goodhart explains: "For some people, talking to someone they're not close to allows them to let their guard down and admit just how tricky it [coping after cancer] is sometimes."

You might feel that you would like to talk to a healthcare professional or to people who have been through similar experiences to you, and there are a number of ways you can find them. You can discuss your feelings and get advice and support from:

  • Your cancer care team – when you finish your treatment they can give you advice on where to go for further support. Depending on your area, they may be able to refer you to a psychologist who specialises in cancer care.
  • Support groups – post-cancer support groups are increasingly available and can be a very positive experience for people who attend. These support groups tend to be very informal and provide a place for people to chat, swap experiences and offer advice and support to each other, if they feel like it. It is generally acceptable to just sit and listen if you prefer. Find a group near you.
  • Cancer support centres such as Maggie's Centres provide relaxed and informal environments to meet other people who have or have had cancer.
  • You can also blog about your experiences and chat to people online via Maggie's online centre.

Further advice on coping after cancer

You may also find the following advice helpful for coping with the physical and emotional after-effects of cancer:

  • Recognise what you've been through and how well you have done.
  • Don't be hard on yourself.
  • Give yourself permission to grieve for what you've lost and, if it feels right for you, find someone you feel you can talk to about it.
  • Don't avoid the issue – we all avoid doing things we find hard, but by doing this difficult feelings can build up and fester.
  • Try to give yourself a goal – something you know you need to do, such as accepting a part of your body that has changed – and gradually build up to it. For example, Dr Goodhart suggests, "If you don't want to go out because you're worried about being stared at, start by making a list of things you could say to any comments people might make, and go out with a friend or partner to a local café for 10 minutes. Then increase the length and frequency of your outings."
  • Re-build your self-esteem  focus on your achievements and take time to assess all the good things that you have done and still have to offer.  
  • Learn to trust your body again – Dr Goodhart explains: "Confidence in your own body can be very damaged by cancer. Your body can feel as though it's failed you and can't be trusted. Every twinge may feel like a sign that the cancer has returned. But you can re-learn your body's signals and, in time, start to have confidence in yourself as a 'healthy person' like you did before the cancer."
  • Try some exercise – when you feel up to it, regular exercise can help you to combat low mood and help you feel physically stronger. Read more about the benefits of exercise on the Macmillan webpage 'Exercise during and after cancer'.
  • Get further advice on tackling depression, anxiety or anger – if you're struggling or worried, talk to your GP or cancer care team. They can discuss diagnosis and treatment options with you, such as talking therapies and medication.

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Vicky's story: 'My gastric band surgery'

Office worker Vicky Finch, 66, had a gastric band fitted in February 2012, following years of failed dieting and increasing concern about her long-term health. She discusses her experiences here.

"My weight had begun to creep up when I was 25 after having children, and in spite of numerous attempts to lose weight, I got heavier with each decade. By the time I reached my fifties, I was having to take medication to control my blood pressure and underactive thyroid.

"I've never been one for sport or exercise and have had a sedentary office job my whole life. While bringing up children and working full-time I developed bad eating habits. I ate too fast, had large portions, snacked on sugary treats and didn't sleep enough. I love cooking, but I'd become obsessed by food.

"I tried combining dieting with going to the gym and went on various slimming programmes. These approaches all worked initially, but I found dieting hard and couldn't keep the weight off long term. I'd soon put it all back on, and more.

"At my heaviest, I weighed 17.5 stone (111kg) and as I'm 5ft 1in this gave me a BMI of 47. I began to have serious concerns about my health. I already had high blood pressure and kidney problems and had had two knee replacements. I knew I was at risk of stroke, heart disease and developing diabetes."

The road to weight loss surgery

"I visited the GP several times about my weight and was encouraged to lose weight through dieting before choosing weight loss surgery (also called bariatric surgery). I was also offered regular appointments with the nurse to weigh myself and discuss my diet.

"Eventually, I learnt about gastric band and gastric bypass surgery. A gastric band is where a band is fitted around the top of your stomach. This causes a feeling of fullness after eating a very small amount of food, and means that food must be eaten very slowly.

"My surgeon gave me lots of information about weight loss surgery, including all the risks as well as the benefits. Following an assessment of my suitability, and after a lot of time considering the advice, I opted to have a gastric band as it's reversible, and I felt a gastric bypass  where a smaller stomach is made  was too extreme for me."

The gastric band procedure

"I was put on a liquid diet two weeks before the operation in order to shrink my liver and to get me used to being on a liquid diet afterwards. The operation went very smoothly. I stayed in hospital overnight, but I felt well enough to go home straight away. I was left with a port under the skin which is attached to an upper rib. This is so that saline can be injected into the gastric band through the port every six to eight weeks, until the right level of restriction is achieved.

"The follow-up I received after the operation was good. I could discuss my progress, including any difficulties I was having, with a team of dietitians and nurses. After I'd followed a liquid, then soft food diet for a few weeks, the nurse injected the first 5ml (one teaspoon) of saline into the port.

"After eight months, I now have 10.5ml in my band out of a possible 14ml, and I'm really starting to feel the restriction. I thought the feeling of restriction would be immediate, but it has taken time."

Living with a gastric band

"Before the operation, I thought, 'This gastric band is going to be the magic wand'. However, people need to be able to commit to making necessary changes following surgery. I didn't realise what big efforts I'd have to make to change the way I eat. For example, as well as eating more healthily, I always have to take small mouthfuls and chew slowly and thoroughly. To help me control my portion sizes I have to eat from a tea plate rather than a dinner plate, and spend no more than 20 minutes on each meal.

"It's not easy. If I'm hungry, I tend to fall back into bad habits of eating fast and not chewing properly. When this happens, I quickly become very uncomfortable and have to stop eating and wait until some food moves through the artificial neck in my stomach sac. Sometimes, if I have a bad reaction, I end up retching saliva, which is quite antisocial.

"Having a gastric band has made me more cautious towards food. Although I still get hungry, I know that if I don't take smaller mouthfuls I'll feel uncomfortable or be sick. I'm lucky, though – I can now eat almost anything, which not everyone who has a gastric band can. The only food I have to avoid is crusty bread, as I react badly to it.

"So far, my only regret has been that I couldn't lose the weight without the surgery. It was difficult telling family and friends about my decision at first. But since having my gastric band fitted, the weight is slowly but steadily coming off. I've lost two-and-a-half stone and dropped two dress sizes.

"After eight months I'm now 15 stone (BMI 39). My target weight is 9-9.5 stone (BMI 24). I'm trying to introduce more exercise, which will make me lose weight more quickly, and I look forward to a healthier, more fulfilled life, with less need for medication."

Vicky's advice to people considering a gastric band

"For anyone considering gastric band surgery, my advice is to read up about it and spend time thinking it through first. It's important to be realistic about what will happen after the surgery, to understand that you'll never be able to eat the same way as you did before, and to appreciate that the weight loss process takes time.

"You also have to do a lot of the hard work yourself. I think it's easy to be swayed by gastric band success stories in the media, which can hold people back from accepting what the realities of the surgery are. If you don't think you'll be able to make permanent, healthy changes to your diet, then it's probably not for you.

"Personally, the restriction of the band has actually made me feel more liberated in general. I now have control over food; it doesn't control me. And my husband has noticed that I'm slimmer and can move around better!"

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'Strength and Flex keeps me motivated'

Self-confessed couch potato Anne MacLaren hadn't done any exercise for 10 years until she made a New Year's resolution to “get her act together”.

The north Londoner says the Strength and Flex workout plan was just what she was looking for to keep her motivated.

Where did you find out about Strength and Flex?

"I did Couch to 5K, which I really enjoyed but I felt I needed something else to tone my arms and tummy. The running was good for my cardio but I felt my upper body wasn't getting enough exercise. I came across Strength and Flex on NHS Choices. I tried the level 1 podcast and I liked it, it was exactly what I was looking for."

 

How active are you?

"One of my many New Year's resolutions was to get fit. I used to be a real couch potato. I had stopped exercising for 10 years. Now, I run three times a week; I’ll do Strength and Flex two or three times a week and a Zumba class once a week."

 

Why did you decide to get more active?

"A friend wanted us to do a 5K charity run together and I used that as an opportunity to get back into shape. I was aware that I had neglected my fitness for a while. I just thought: 'Wait a minute, I've got to get my act together'."

 

How often do you do Strength and Flex?

"When I was working through the programme, I’d do each routine three times a week before moving up a level. I liked the way it gradually got tougher so I felt I made progress each week. Now I just use the no-intro version of level 5."

 

Where do you do Strength and Flex?

"I've done a couple of sessions indoors when the weather was very bad, but I much prefer to go outside even when it is cold and damp. I like exercising in the fresh air. I’ve got a park nearby and there are benches and some railings, which you need for some of the exercises, like the pull-ups and bench dips."

 

Do you ever feel self-conscious in the park?

"I still feel a bit self-conscious at times so I try to do it when I know the park is quiet. But I do see others in the park exercising so I don't really stand out. I'll do a session with a friend once a week. I'll listen to the podcast and I'll repeat the instructions to her as I hear them. We both know the exercises so well now that just a bit of prompting is enough. It's a good laugh and you forget about your surroundings!"

 

Has your health improved since starting Strength and Flex?

"I've noticed a massive change. I feel a lot more energetic and I'm on the go a lot more. My general health is better. I feel much more alive. I really enjoy exercising outside as it really lifts my mood. That's one of the great things about Strength and Flex and Couch to 5K."

 

What do you like about the Strength and Flex workout plan?

"I like that it's in a podcast. I've got the series stored on my MP3 player. It means I can take it anywhere and fit in a workout whenever convenient. I don't need a gym or any equipment. I also like having a voice in my ear talking me through the exercises. I feel there's somebody encouraging me. It helps keep up the pace. It's really motivating and stops your mind wandering. It's a bit like having a personal trainer next to you, but a lot cheaper. And also the exercises are fun to do!"

 

Did you find the Strength and Flex exercises challenging?

"I found the squats and the bench dips a bit of a challenge at first. I used to get painful knees when I exercised before and I had weak arms. Fortunately, the change between levels is gradual, you never feel like there's a big leap between levels but you're always progressing. I now feel my knees and arms are stronger."

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Twelve tips for a healthy Christmas

From defrosting turkey to using leftovers, these food safety tips will help stop your turkey from knocking the stuffing out of you this Christmas.

Avoid cross-contamination

Keep all raw food, whether it's turkey or vegetables, separate from ready-to-eat foods to avoid cross-contamination. Use separate chopping boards for raw food and ready-to-eat food. Raw foods can contain harmful bacteria that are spread very easily to anything they touch, including other foods, worktops, chopping boards and knives.

 

Set the fridge to 5°C

Store food that needs to be chilled in the fridge until you need it. Make sure the fridge temperature is below 5°C. Don't pack food too tightly, as the cold air needs to circulate to cool food down. If you're storing food such as fresh vegetables outside in a garage or shed, keep them in a sealed container.

 

Wash your hands

Always wash and dry your hands thoroughly before and after handling food, especially when handling and preparing raw meat and poultry. You also need to remember to wash and dry your hands after going to the toilet, touching the bin or touching any pets. Bugs are spread between food, surfaces and utensils most effectively on wet or damp hands.

 

Defrost turkey safely

Defrost the turkey on a large dish and cover, preferably in the fridge. Remove the giblets and the neck to speed up thawing. Alternatively, defrost the turkey in a cool, clean place where the temperature is fairly constant. Keep in mind that the temperature of where the turkey is kept will affect thawing times.

 

Turkey defrosting times

It can take up to 48 hours for a large turkey to thaw. To work out the defrosting time for your turkey, check the packaging. If there aren't any defrosting instructions, use the following times as a guide:

  • in a fridge at 4ºC (39ºF), allow about 10 to 12 hours per kg
  • in a cool room (below 17.5ºC, 64ºF), allow approximately three to four hours per kg
  • at room temperature (about 20ºC, 68ºF), allow approximately two hours per kg

A turkey is fully defrosted when there are no ice crystals inside the cavity and the meat is soft when you insert a fork or skewer. Once thawed, store it in the fridge until you are ready to cook it. If this isn't possible, you should cook it immediately.

 

Don't wash the bird

Eighty per cent of people say they wash their turkeys before cooking them, but this significantly increases the risk of food poisoning by splashing germs around the kitchen. Don't wash your bird, because it will only spread germs. Thorough cooking will kill any bacteria that might be present.

 

Cook turkey properly

Seventeen per cent of people aren't sure how to tell when their turkey is cooked. Make sure your turkey is steaming hot all the way through before serving. When you cut into the thickest part of the turkey, none of the meat should be pink. If juices flow out when you pierce the turkey or when you press the thigh, they should be clear. If you're using a temperature probe or food thermometer, ensure that the thickest part of the bird (between the breast and the thigh) reaches at least 70°C for two minutes.

Find out more about turkey cooking times.

 

Goose and other birds

Other birds, such as goose and duck, have different cooking times and temperatures. The oven should always be hotter for duck and goose in order to melt the fat under the skin.

  • goose should be cooked in a preheated oven at 200ºC/425ºF/Gas Mark 7 for 35 minutes per kg
  • duck should be cooked in a preheated oven for 45 minutes per kg at 200ºC/400ºF/Gas Mark 6
  • chicken should be cooked in a preheated oven at 180ºC/350ºF/Gas Mark 4 for 45 minutes per kg plus 20 minutes

 

Wash your veg

Most of the bacteria on vegetables will be in the soil attached to the produce. Washing to remove any soil is therefore particularly important. When you wash vegetables, don't just hold them under the running tap. Rub them under water, for example in a bowl of fresh water. Start with the least soiled items first and give each of them a final rinse. Washing loose produce is particularly important, as it tends to have more soil attached to it than pre-packaged fruit and vegetables.

 

Know your dates

Sniffing food is not a reliable way of telling whether food is still safe to eat. Some harmful bacteria don't always change the way foods smell, taste or look. Food with a "use-by" date goes off quite quickly and it can be dangerous to eat after this date.
Food with a "best before" date is longer-lasting. It may not be at its best quality after this date but should be safe to eat. Eggs can be eaten a day or two after their best before date, as long as they are cooked thoroughly until both yolk and white are solid, or if they are used in dishes where they will be fully cooked, such as a cake.

 

Preparing a buffet

Cold items for a buffet should remain covered and in the fridge until the last minute. Don't keep them out for more than four hours. Food kept out for longer could be open to harmful bacteria if left to get warm at room temperature. Foods which are cooked and intended to be served cold should be cooled as quickly as possible, ideally within one to two hours. You can cool food down faster by separating it into small batches, placing it in a container and placing the container in a shallow dish of cold water.

 

Cool leftovers

Cool leftovers as quickly as possible, ideally within 90 minutes, then cover and refrigerate. Splitting food into smaller portions can help cooling. Use leftovers within two days and reheat until they are steaming hot all the way through. Don't reheat leftovers more than once. If you want to keep leftovers longer than two days, you can freeze them instead. Cool leftovers as described above before putting them in the freezer. Once defrosted, don't refreeze the leftovers unless you cook them again first.

Get tasty recipe ideas to use up leftovers.

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Christmas leftovers recipe ideas

From turkey to Christmas cake, check out these recipe ideas from Love Food Hate Waste for creative ways to use up your Christmas meal leftovers.


Turkey leftovers

Leftover poultry such as turkey, goose, chicken or duck can be used in a variety of ways, from sandwiches and stir fries to soups and salads.

Recipe ideas:

If you don't think you will get around to eating the meat before it goes off, you can always slice it and freeze it for another time. When you are ready to use it, defrost it in the fridge and use it the same day.

 

Roast beef leftovers

  • Beef hotpot
    Try combining leftover roast beef with leftover gravy and vegetables from the Christmas dinner, top with a layer of sliced cooked potatoes and you'll have a hearty hotpot ready to go on Boxing Day.
  • Yorkshire pudding canapés
    You could also try serving roast beef-topped Yorkshire puddings  place slices of roast beef inside mini Yorkshire puds with a bit of English mustard or horseradish. They can be served hot with gravy, or cold as a canapé.
  • Mince beef
    Beef can also be minced and used as a filling for cottage pie or a bolognaise sauce

 

Leftover stuffing

Leftover stuffing will combine perfectly with leftover cooked vegetables such as Brussels sprouts, carrots, parsnips and potatoes to make bubble and squeak.  

 

Leftover vegetables

Potatoes, carrots and parsnips combine wonderfully with stock to make a warming root vegetable soup. You can also chop them up into cubes and add some herbs, fry them in a little olive oil and serve with cold leftover meats.

Recipe ideas:

 

Leftover Christmas pudding

Christmas pudding keeps very well, but once opened it is best stored in the fridge. If you have some left over, why not try making a Christmas pudding strudel. You can also reheat pudding and serve it warmed with ice cream or custard. Or if you want a taste of Christmas even after the holiday ends, you can make Christmas pudding muffins.

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The placebo effect

When a person uses any type of health treatment and sees an improvement in their symptoms, they may be experiencing the placebo effect. That’s why it’s important to be aware of the placebo effect when judging the effectiveness of a treatment, or when using one ourselves.

The placebo effect is about the power of the mind to influence the body.

It can occur when a person uses any kind of health treatment, either conventional or complementary and alternative.

It can affect all of us, whether we know about the placebo effect or not.

It’s important to be aware of the placebo effect when choosing complementary and alternative treatments. That is because if we choose a complementary or alternative treatment that does not work – and causes only a placebo effect – we may miss out on more effective treatments.

What is the placebo effect?

For hundreds of years, doctors have known that when a patient with a health condition expects their symptoms to improve, they often do improve.

Today, we know that patients who are given empty injections or pills that they believe contain medicine can experience improvement in a wide range of health conditions. This kind of fake or empty medicine is often called a placebo, and the improvement that results is called the placebo effect.

The placebo effect is an example of how our expectations and beliefs can cause real change in our physical bodies. It’s a phenomenon that we don’t completely understand. But we can see it working in all kinds of ways, and all kinds of circumstances.

The placebo effect at work

Take one well-known example based on a physical feeling we are all familiar with: pain.

In 1996, scientists assembled a group of students and told them that they were going to take part in a study of a new painkiller, called 'trivaricaine'. Trivaricaine was a brown lotion to be painted on the skin, and smelled like a medicine. But the students were not told that, in fact, trivaricaine contained only water, iodine, and thyme oil, none of which are painkilling medicines. It was a fake – or placebo – painkiller. Read an abstract of the study: Mechanisms of Placebo Pain Reduction.

With each student, the trivaricaine was painted on one index finger, and the other left untreated. In turn, each index finger was squeezed in a vice. The students reported significantly less pain in the treated finger, even though trivaricaine was a fake.

In this example, expectation and belief produced real results. The students expected the 'medicine' to kill pain: and, sure enough, they experienced less pain. This is the placebo effect.

Placebo medicine has even been shown to cause stomach ulcers to heal faster than they otherwise would.

These amazing results show that the placebo effect is real, and powerful. They mean that fake or placebo treatments can cause real improvements in health conditions: improvements we can see with our own eyes.

Experiencing the placebo effect is not the same as being 'tricked', or being foolish. The effect can happen to everyone, however intelligent, and whether they know about the placebo effect or not.

CAM and the placebo effect

Evidence about a treatment is gathered by conducting fair tests. In these tests, scientists find out whether a treatment causes an improvement beyond the improvement caused by the placebo effect alone.

Evidence plays an important role in mainstream medicine. This means that when you use many conventional medicines, you can be sure that there is evidence that they work.

When patients experience improvement after using a healthcare treatment that has not been proven to work, they may be experiencing only the placebo effect.

Of course, improvement in a health condition due to the placebo effect is still improvement, and that is always welcome.

But it is important to remember that for many health conditions, there are treatments that work better than placebo treatments. If you choose a treatment that provides only a placebo effect, you will miss out on the benefit that a better treatment would provide.

Check the evidence

The only way to know whether a health treatment works better than a placebo treatment is by checking the evidence.

You can learn more about evidence, how it is gathered, and why it is important in CAM: what is evidence?.

You can learn about the evidence for many of the best-known complementary and alternative medicines in the Health A-Z pages.

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How to choose a CAM practitioner

If you have decided to use a complementary or alternative medicine (CAM), you’ll need to find a practitioner who will carry out the treatment in a way that is suitable for you.

If you think you may have a health condition, first see your GP. Do not use a visit to a complementary and alternative medicines practitioner as a substitute for a visit to a GP.

When you’re deciding whether or not to use a complementary or alternative medicine, the first step is to learn as much as possible about the treatment.

You should find out:

  • What is the evidence that this treatment is safe for you to take? For example, ginseng has been associated with higher blood pressure and may be inappropriate if you already have raised blood pressure (hypertension).
  • If you are using the complementary or alternative medicine to treat a health condition, what is the evidence that the treatments works for your condition?

You can learn more about evidence in What is evidence?

For further advice on whether to use a complementary or alternative medicine, talk to your GP. It’s particularly important to talk to your GP if you have a pre-existing health condition, or are pregnant. Some complementary and alternative medicines may interact with medicines that you are taking.

Finding a practitioner

If you’ve learned about a particular complementary and alternative medicine and you want to use it, you’ll need to find a practitioner.

Various organisations exist that can help you to do this.

See How CAM is regulated for more information about regulation of CAMs, and the organisations associated with various CAMs.

Osteopathy and chiropractic

Currently, practitioners of two complementary and alternative medicines are regulated in the same way as practitioners of conventional medicine. They are osteopathy and chiropractic. This regulation is called statutory professional regulation.

These regulatory bodies can help you to find a registered practitioner, but they do not “recommend” particular registered practitioners.

  • You can use the website of the General Osteopathic Council to find a registered osteopath near you, or check if someone offering osteopathic services is registered.
  • You can use the website of the General Chiropractic Council to find a registered chiropractor near you, or check if someone offering chiropractic services is registered.

Never use an unregistered practitioner of osteopathy or chiropractic.

Other complementary and alternative treatments

In the UK, there is currently no statutory professional regulation of any other complementary and alternative medicines practitioners.

This means that some practitioners of these treatments may have no or limited formal training or experience. To find out more about this see How CAM is regulated.

In the case of many CAMs, there are voluntary registers or professional associations that practitioners can join if they choose. For example:

Their websites each lists practitioners who have registered with them across a wide range of therapies, such as aromatherapy, reflexology, massage therapy and Alexander technique.

You can use evidence to check whether the claims made by professional bodies about their treatments are true. Learn more about evidence and why it is important in What is evidence?.

Other professional associations hold membership lists or registers of practitioners of specific complementary and alternative medicines. Examples include:

You can find more professional associations for a particular treatment in the relevant Health A-Z page.

Health and safety in acupuncture

Although there is no statutory regulation of acupuncture, anyone practising acupuncture must register with their local authority (council) for health and safety reasons.

This is because of the risks of blood-borne diseases from piercing the skin with acupuncture needles. These rules also cover tattooing and cosmetic piercings.

The local authority must also ensure that it has byelaws that govern the cleanliness of the acupuncture premises, practitioners, instruments, materials and equipment. Disposable needles are recommended.

Once you have found a practitioner

If you have found specific practitioners, you should ask some key questions before you begin treatment.

It’s a good idea to approach more than one practitioner, so that you can compare them for training and experience, as well as compare the service they offer and the cost.

Ask for proof

Any good practitioner should be happy to answer questions about their qualifications and experience. You should also consider asking for:

  • documentary proof of their qualifications
  • documentary proof that they are a member of their statutory regulatory body, a voluntary register or a professional association
  • documentary proof that they are insured
  • written references

Questions to ask

Once you are satisfied on the above, ask key questions on the service provided by the practitioner. This can help prevent problems later on.

What is the cost of treatment?

If, in addition to appointments, there are treatments that you must buy – for example, homeopathic remedies – what will they cost? Is there a charge for cancelling an appointment? Some of the organisations that support CAM practitioners may be able to give you an idea of the typical cost of treatment.

How long will the CAM treatment last?

This will vary depending on individual circumstances, but your practitioner should be able to give an estimate. The practitioner should provide you with a treatment plan that includes the number of treatments necessary to determine whether the treatment is helping. You should not have to commit to long stretches of treatment in advance, and you should discuss whether you will be asked to pay in advance of sessions.

Are there any people who should not use this treatment?

If you are pregnant or have a health condition, talk to your GP too.

What side effects might the treatment cause?

For example, are you likely to feel tired or uncomfortable afterwards? This may impact on your plans for the rest of the day, and on how you will get home.

Is there anything you should do to prepare for treatment?

What system does the practitioner have for dealing with complaints about their treatment or service?

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CAM: what is evidence?

The only way to find out whether a health treatment works and is safe is to test it. The results of these tests are called evidence. Evidence can help you when you’re deciding whether to use a complementary and alternative medicine.

Every day, we make decisions by using our common sense and intuition. But when choosing between different health treatments, often these tools are not enough.

For example, we may hear from a friend that a particular alternative treatment helped improve her asthma. At first, there might seem an obvious conclusion: the treatment works. But beware: the experience of a single individual does not prove that a treatment works.

Our friend may have been experiencing the placebo effect. Or the improvement may have had another cause, or been simply due to the passing of time. And remember that any medicine or treatment may work differently for different people.

So how can we really judge whether a treatment is safe, and is likely to work?

The answer lies with the results of fair tests: evidence. Without evidence, we risk choosing treatments that don’t work, or, even worse, that can do us serious harm.

The role of evidence in medicine

Evidence plays an important role in conventional medicine.

Practitioners of conventional medicine strive to use treatments that are supported by clinical evidence showing they are safe and that they work. Still, the use of treatments in conventional medicine is not always based on scientific evidence.

In these cases, use of treatment is based on the clinical experience and training of the health professionals – GPs, nurses, doctors – involved.

Evidence, CAM and the NHS

The National Institute for Health and Clinical Excellence (NICE) uses evidence when it draws up guidance for the NHS on use of treatments and care of patients.

Currently, NICE recommends the use of a complementary and alternative treatment in a limited number of instances, including:

  • Alexander Technique for Parkinson’s disease
  • ginger and acupressure for reducing morning sickness
  • acupuncture and manual therapy, including spinal manipulation, spinal mobilisation and massage for persistent low back pain

Gathering and using evidence

The best way to produce good evidence on a health treatment is to conduct a fair test of the treatment. Here, the medicine or treatment being tested is compared to another treatment, or to a fake version of the treatment, called a placebo. To learn more about the placebo effect, read What is the placebo effect?.

Tests are made as fair as possible by minimising bias and the role of chance. That means that the results of the test will reflect, as far as possible, the truth about the medicine or treatment, and will not be influenced by other factors such as the way the test was carried out, or the attitudes of the people who take part.

Scientists often call these fair tests 'clinical trials'. You can learn more in our Health A-Z pages on clinical trials.

Before scientists conclude that a health treatment is safe and that it works, there must usually have been several independent tests of the treatment that have shown this.

Sometimes, different fair tests can give results that disagree.

Evidence for and against

The results of fair tests can provide:

  • Results that show that the medicine or treatment does work, and is safe. This is often call positive evidence, or evidence for the treatment.
  • Results that show that the medicine does not work, or is unsafe. This is often called negative evidence, or evidence against the treatment.

Scientists usually like to see the results of a number of fair tests before they begin to draw conclusions.

It is important to remember that negative evidence – that is, evidence against a treatment – is not the same as no evidence. Negative evidence means a set of results showing that a medicine or treatment does not work. No evidence simply means an absence of any evidence, because fair tests have not been conducted.

Where to find evidence

You can read more about evidence by searching the NHS Evidence website.

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All about complementary and alternative medicine

Complementary and alternative medicines are treatments that fall outside of mainstream healthcare.

These medicines and treatments range from acupuncture and homeopathy to aromatherapy, meditation and colonic irrigation.

There is no universally agreed definition of complementary and alternative medicine (CAM).

The information that tells whether a healthcare treatment is safe and effective is called evidence. You can use evidence to help you decide whether you want to use a CAM. Detailed information on many complementary and alternative treatments can be found listed alphabetically in the Health A-Z index.

Some complementary and alternative medicines or treatments are based on principles and an evidence base that are not recognised by the majority of independent scientists.

The availability of complementary and alternative treatments on the NHS is limited. Some, such as acupuncture, may be offered by the NHS in some circumstances.

'Alternative' and 'complementary' defined

Although 'complementary and alternative' is often used as a single category, it can be useful to make a distinction between complementary and alternative medicine.

This distinction is about two different ways of using these treatments:

  • Treatments are sometimes used to provide an experience that is pleasant in itself. This can include use alongside conventional treatments, to help a patient cope with a health condition. When used this way the treatment is not intended as an alternative to conventional treatment. The US National Center for Complementary and Alternative Medicine (NCCAM) says that use of treatments in this way can be called complementary medicine.
  • Treatments are sometimes used instead of conventional medicine, with the intention of treating or curing a health condition. The NCCAM says that use of treatments in this way can be called alternative medicine.

There can be overlap between these two categories. For example, aromatherapy may sometimes be used as a complementary treatment, and in other circumstances is used as an alternative treatment.

A number of complementary and alternative treatments are typically used with the intention of treating or curing a health condition. Examples include:

  • homeopathy
  • acupuncture
  • osteopathy
  • chiropractic
  • herbalism

Evidence and complementary or alternative treatments

Given the extremely wide range of complementary and alternative medicines on offer, how can we decide whether to use one of these treatments?

To make such a decision, we need evidence on whether a treatment is safe and effective. You can learn more about how evidence is obtained, why it is important, and how to use it, by reading What is evidence?.

You can learn more about the evidence for particular CAMs by reading about that CAM in Health A-Z.

We also need to find out whether there is a suitable practitioner available to administer it. You can learn more in Choosing a CAM practitioner.

It’s important to remember that when a person uses any health treatment – including a complementary or alternative medicine – and experiences an improvement, this may be due to the placebo effect. You can learn more about the placebo effect by reading What is the placebo effect?.

In a few cases, certain complementary and alternative treatments have been proven to work for a limited number of health conditions. For example, there is good evidence that osteopathy, chiropractic and acupuncture work to treat persistent low back pain. These treatments are named in the NICE guidance on treatment of persistent low back pain.

Complementary and alternative medicine and the NHS

In most cases the NHS does not offer patients complementary or alternative treatments.

The National Institute for Health and Clinical Excellence (NICE) provides guidance to the NHS on the clinical and cost effective use of treatments and care of patients. NICE has recommended the use of complementary and alternative medicines in a limited number of circumstances.

For example:

  • the Alexander Technique for Parkinson’s disease
  • ginger and acupressure for reducing morning sickness
  • acupuncture and manual therapy, including spinal manipulation, spinal mobilisation and massage for persistent low back pain

NICE bases its recommendations on the available scientific evidence for the clinical and cost-effectiveness of treatments.

Find a CAM practitioner

If you do decide to use a complementary or alternative treatment, you’ll often need to find a practitioner.

Apart from osteopathy and chiropractic, there is currently no professional statutory regulation of complementary and alternative treatments in the UK. That means it is legal for anyone to practise the treatment, even if they have no or limited formal qualifications or experience. Learn more in How CAM is regulated.

Some regulated healthcare professionals – such as GPs – also practise unregulated CAMs. In these instances, the CAM practice is not regulated by the organisation that regulates the healthcare professional, though these organisations will investigate complaints that relate to the professional conduct of their member.

If you decide to use a CAM, it’s up to you to find a practitioner who will carry out the treatment in a way that is acceptable to you.

Professional bodies and other organisations can help you to do this. You can learn more by reading Finding a CAM practitioner.

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How CAM is regulated

The practice of conventional medicine is regulated by special laws that ensure that practitioners are properly qualified, and adhere to certain standards or codes of practice.

This is called statutory professional regulation. Professionals of two complementary and alternative treatments – osteopathy and chiropractic – are regulated in the same way. But there is no statutory professional regulation of any other complementary and alternative medicine (CAM) practitioners. For more information read Professional misconduct.

Most complementary and alternative medicine practitioners are not regulated by professional statutory regulation. This means it is up to you to find out whether your practitioner has qualifications, and will conduct treatment in a way that is acceptable to you.

Many complementary and alternative medicines have professional associations and/or voluntary registers, which practitioners can join if they choose. Usually, these associations or registers demand that practitioners hold certain qualifications, and agree to practice to a certain standard. However, in these cases there is no legal requirement that practitioners join an association or register before they start to practise.

You can learn more about using a professional association or voluntary register to find a practitioner by reading Finding a CAM practitioner.

Regulation of complementary and alternative medicine

Currently, practitioners of two complementary and alternative medicines are regulated in the same way as practitioners of conventional medicine. They are osteopathy and chiropractic. This regulation is called statutory professional regulation.

This regulation ensures that registered practitioners of osteopathy and chiropractic are properly qualified, and that they practise in a way that is safe and ethical, following the standards and codes set by their professional regulators.

These regulatory bodies can help you to find a registered practitioner, but they do not 'recommend' particular registered practitioners.

  • All osteopaths must be registered with the General Osteopathic Council. It is illegal to call yourself an osteopath, or offer services as an registered osteopathy, without registration. You can learn more, and find a registered osteopath near you, at the website of the General Osteopathic Council.
  • All chiropractors must be registered with the General Chiropractic Council. It is illegal to call yourself a chiropractor, or offer services as a registered chiropractor, without registration. You can learn more, and find a registered chiropractor, at the website of the General Chiropractic Council.

Regulation exists to protect patient safety: it does not by itself mean that there is scientific evidence that a treatment is effective. To find out whether a treatment is effective, you need to learn more about the evidence for that treatment.

Learn more about the evidence for osteopathy. Learn more about the evidence for chiropractic.

Unregulated complementary and alternative medicines

In the UK, there is currently no statutory professional regulation of any other complementary and alternative medicine practitioners.

This means, for example, that anyone in the UK can legally call themselves a homeopath and practise homeopathy on patients, even if they have no training or experience. These practitioners are not legally required to adhere to any standards of practice. If you have a complaint about treatment you have received from a homeopath, you have no special legal rights beyond normal civil and criminal law.

The same applies to all other complementary and alternative medicines, except osteopathy and chiropractic (see above). This means that some practitioners of these treatments may have no or limited formal training or experience.

If you want to use an unregulated complementary or alternative medicine, it’s up to you to find a practitioner who will practise in a way that is acceptable to you.

Some regulated practitioners of conventional medicine also practice unregulated CAMs. For example, the Faculty of Homeopathy is a voluntary organisation for statutorily regulated health professionals, such as GPs, who also practise homeopathy. The organisations who regulate these professionals do not regulate their CAM practice, but would investigate concerns that relate to the professional conduct of their registered practitioner.

Voluntary registers

In the case of many complementary and alternative medicines there are professional associations or voluntary registers that practitioners can choose to join.

Typically, practitioners can only join these associations or registers if they hold certain qualifications, and agree to adhere to certain standards of practice. However, there is no legal requirement to join and practitioners can still offer services without being a member of any organisation.

If you want to use a complementary and alternative medicine where practitioners are not regulated by professional statutory regulation, you should make use of professional bodies or voluntary registers, where they exist, to help you find a practitioner.

You may want to check what arrangements there are for complaining about a practitioner. For example, does the association or register accept complaints, and what action will they take if you have concerns about your treatment?

Learn more in Choosing a CAM practitioner.

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Balance exercises for older people

These simple balance exercises for older people can be done at home to help improve your health and mobility.

Don't worry if you've not done much exercise for a while, these balance exercises are gentle and easy to follow.

Build up slowly and aim to gradually increase the repetitions of each exercise over time.

Try to do these exercises at least twice a week and combine them with the other routines in this series to help improve strength, balance and co-ordination.

Download this exercise routine as a PDF (813kb)

 

Sideways walking

A. Stand with your feet together, knees slightly bent.

B. Step sideways in a slow and controlled manner, moving one foot to the side first.

C. Move the other to join it.

Avoid dropping your hips as you step. Perform 10 steps each way or step from one side of the room to the other.

 

Simple grapevine

This involves walking sideways by crossing one foot over the other.

A. Start by crossing your right foot over your left.

B. Bring your left foot to join it.

Attempt five cross steps on each side. If necessary, put your fingers against a wall for stability. The smaller the step, the more you work on your balance.

 

Heel-to-toe walk

A. Standing upright, place your right heel on the floor directly in front of your left toe.

B. Then do the same with your left heel. Make sure you keep looking forwards at all times. If necessary, put your fingers against a wall for stability.

Try to perform at least five steps. As you progress, move away from the wall.

 

One-leg stand

A. Start by standing facing the wall, with arms outstretched and your fingertips touching the wall.

B. Lift your left leg, keep your hips level and keep a slight bend in the opposite leg. Gently place your foot back on the floor.

Hold the lift for five to 10 seconds and perform three on each side.

 

Step-up

Use a step, preferably with a railing or near a wall to use as support.

A. Step up with your right leg.

B. Bring your left leg up to join it.

C. Step down again and return to the start position.

The key for building balance is to step up and down slowly and in a controlled manner. Perform up to five steps with each leg.

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Sitting exercises for older people

Performing these gentle sitting exercises designed for older people will help improve your mobility and prevent falls, and can even be done at home.

Don't worry if you've not done much for a while, these seated exercises are gentle and easy to follow.

For these chair-based exercises, choose one that is stable, solid and without wheels.

You should be able to sit with your feet flat on the floor and knees bent at right angles. Avoid chairs with arms, as this will restrict your movement.

Build up slowly and aim to gradually increase the repetitions of each exercise over time.

Try to do these exercises at least twice a week and combine them with the other routines in this series to help improve strength, balance and co-ordination.

Download this exercise routine as a PDF (974kb)

 

Chest stretch

This stretch is good for posture.

A. Sit upright and away from the back of the chair. Pull your shoulders back and down. Extend your arms out to the side.

B. Gently push your chest forwards and up until you feel a stretch across your chest.

Hold for five to 10 seconds and repeat five times.

 

Upper body twist

This stretch will develop and maintain flexibility in the upper back.

A. Sit upright with your feet flat on the floor, cross your arms and reach for your shoulders.

B. Without moving your hips, turn your upper body to the left as far as is comfortable. Hold for five seconds.

C. Repeat on the right side.

Do five on each side.

 

Hip marching

This exercise will strengthen hips and thighs and improve flexibility.

A. Sit upright and do not lean on the back of the chair. Hold on to the sides of the chair.

B. Lift your left leg with your knee bent as far as is comfortable. Place your foot down with control.

C. Repeat with the opposite leg.

Do five lifts with each leg.

 

Ankle stretch

This stretch will improve ankle flexibility and lower the risk of developing a blood clot.

A. Sit upright, hold on to the side of the chair and straighten your left leg with your foot off the floor.

B. With your leg straight and raised, point your toes away from you.

C. Point your toes back towards you.

Try two sets of five stretches with each foot.

 

Arm raises

This exercise builds shoulder strength.

A. Sit upright with your arms by your sides.

B. With palms forwards, raise both arms out and to the side and up as far as is comfortable. 

C. Return to the starting position.

Keep your shoulders down and arms straight throughout. Breathe out as you raise your arms and breathe in as you lower them. Repeat five times.

 

Neck rotation

This stretch is good for improving neck mobility and flexibility.

A. Sit upright with your shoulders down. Look straight ahead.

B. Slowly turn your head towards your left shoulder as far as is comfortable. Hold for five seconds and return to the starting position.

C. Repeat on the right.

Do three rotations on each side.

 

Neck stretch

This stretch is good for loosening tight neck muscles.

A. Sitting upright, look straight ahead and hold your left shoulder down with your right hand.

B. Slowly tilt your head to the right while holding your shoulder down.

C. Repeat on the opposite side.

Hold each stretch for five seconds and repeat three times on each side.

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Strength exercises for older people

Strength exercises for older people like these can be done at home to help improve your health and mobility.

Don't worry if you've not done much for a while, these strength exercises are gentle and easy to follow.

For these chair-based exercises, choose a chair that is stable, solid and without wheels.

You should be able to sit with your feet flat on the floor and knees bent at right angles. Avoid chairs with arms, as this will restrict your movement.

Build up slowly and aim to gradually increase the repetitions of each exercise over time.

Try to do these exercises at least twice a week and combine them with the other routines in this series to help improve strength, balance and co-ordination.

Download this exercise routine as a PDF (1.2mb)

 

Sit-to-stand

This exercise is good for improving leg strength.

A. Sit on the edge of the chair, feet hip-width apart. Lean slightly forwards.

B. Stand up slowly using your legs, not arms. Keep looking forward and don't look down.

C. Stand upright before slowly sitting down, bottom-first.

Aim for five repetitions  the slower the better.

 

Mini-squats

A. Rest your hands on the back of the chair for stability and stand with your feet hip-width apart.

B. Slowly bend your knees as far as is comfortable, keeping them facing forwards. Aim to get them over your big toe. Keep your back straight at all times.

C. Gently come up to standing, squeezing your buttocks as you do so.

Repeat five times.

 

Calf raises

A. Rest your hands on the back of a chair for stability.

B. Lift both heels off the floor as far as is comfortable. The movement should be slow and controlled. Repeat five times.

To make this more difficult, perform the exercise without support.

 

Sideways leg lift

A. Rest your hands on the back of a chair for stability.

B. Raise your left leg to the side as far as is comfortable, keeping your back and hips straight. Avoid tilting to the right.

C. Return to the starting position. Now raise your right leg to the side as far as possible.

Raise and lower each leg five times.

 

Leg extension

A. Rest your hands on the back of a chair for stability.

B. Standing upright, raise your left leg backwards, keeping it straight. Avoid arching your back as you take your leg back. You should feel the effort in the back of your thigh and bottom.

C. Repeat with the other leg.

Hold the lift for up to five seconds and repeat five times with each leg.

 

Wall press-up

A. Stand arm's length from the wall. Place your hands flat against the wall at chest level with your fingers pointing upwards.

B. With your back straight, slowly bend your arms keeping your elbows by your side. Aim to close the gap between you and the wall as much as you can.

C. Slowly return to the start.

Attempt three sets of five to 10 repetitions.

 

Bicep curls

A. Hold a pair of light weights (filled water bottles will do) and stand with your feet hip-width apart.

B. Keeping your arms by your side, slowly bend them until the weight in your hand reaches your shoulder.

C. Slowly lower again.

This can also be carried out while sitting. Attempt three sets of five curls with each arm.

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Flexibility exercises for older people

These flexibility exercises for older people can be done at home to help improve your health and mobility.

Don't worry if you've not done much for a while, these flexibility exercises are gentle and easy to follow.

Build up slowly and aim to gradually increase the repetitions of each exercise over time.

Try to do these exercises at least twice a week and combine them with the other routines in this series to help improve strength, balance and co-ordination.

Download this exercise routine as a PDF (772kb)

 

Neck rotation

This stretch is good for improving neck mobility and flexibility.

A. Sit upright with shoulders down. Look straight ahead.

B. Slowly turn your head towards your left shoulder as far as is comfortable. Hold for five seconds and return to the starting position.

C. Repeat on the right.

Do three rotations on each side.

 

Neck stretch

This stretch is good for loosening tight neck muscles.

A. Sitting upright, look straight ahead and hold your left shoulder down with your right hand.

B. Slowly tilt your head to the right while holding your shoulder down.

C. Repeat on the opposite side.

Hold each stretch for five seconds and repeat three times on each side.

 

Sideways bend

This stretch will help restore flexibility to the lower back.

A. Stand upright with your feet hip-width apart and arms by your sides.

B. Slide your left arm down your side as far as is comfortable. As you lower your arm, you should feel a stretch on the opposite hip.

C. Repeat with your right arm.

Hold each stretch for two seconds and perform three on each side.

 

Calf stretch

This stretch is good for loosening tight calf muscles.

A. Place your hands against a wall for stability. Bend the right leg and step the left leg back at least a foot's distance, keeping it straight. Both feet should be flat on the floor.

B. The left calf muscle is stretched by keeping the left leg as straight as possible and the left heel on the floor.

C. Repeat with the opposite leg.

Perform three on each side.

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How to stretch after a run

Performing stretching exercises after a run will help you cool down gradually, improve your flexibility and prevent injury.

These stretches from physiotherapist Sammy Margo are best done after exercising, when your muscles are warm and more elastic.

Breathe deeply and regularly during the stretches. Aim to stretch to the point of feeling tightness or slight discomfort.

You should not feel any pain when doing these exercises. If you do, stop and seek medical advice.

Hip flexor stretch  hold for 15 seconds

 

Step your left leg forward, keeping both feet pointing straight ahead. Keeping your back leg straight and avoiding sticking your buttock out and arching your back, slowly bend your front leg and push your right buttock forward until you feel a stretch across the front of your right hip joint. Repeat with the other leg.

 

Thigh stretch  hold for 15 seconds

 

Grab the top of your left foot behind you and gently pull your heel towards your left buttock to stretch the front of the thigh, keeping the knees touching. Avoid leaning forwards or to the side. Repeat with the other leg.

Tip: place a hand on a wall or bench for balance

 

Hamstring stretch  hold for 15 seconds

 

Stand with your right leg just in front of the other and your hands on your hips. Keeping your right leg straight and toes pointing up, bend your left leg. Bend towards your right leg, keeping your back straight.

 

ITB (iliotibial band) stretch  hold for 15 seconds

 

To stretch your right ITB, cross your right leg behind your left leg. Keeping both feet on the ground, lean to your left side and push you right hip outwards. Don’t bend forwards or stick your buttocks out. You should feel the stretch along your outer right thigh and hip.

 

Calf stretch  hold for 15 seconds

 

Step your right leg forward. Bend your front leg and keep your back leg straight. Both feet should point forwards. Push your left heel into the ground, keeping your left leg straight. You should feel the stretch at the back of your left leg, below the knee. Repeat with the opposite leg.

 

Lower back stretch  hold for 15 seconds

 

Lie on your back with both feet flat. Pull your right knee to your chest until you feel a stretch in your lower back. Hold for up to 15 seconds and repeat with the left leg. Then pull both knees to your chest and hold for up to 15 seconds. 

 

Buttock stretch  hold for 15 seconds

 

Lie on your back with your knees bent and both feet flat on the floor. Cross your right leg over your left thigh. Grasp the back of your left thigh with both hands and pull the left leg toward your chest. Repeat with the opposite leg.

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Knee exercises for runners

These knee strengthening exercises will help with your running, strengthen the muscles around the knee and prevent knee pain.

The exercises from physiotherapist Sammy Margo strengthen all the muscles supporting the knee, including the vastus medialis – also known as the teardrop muscle – and stretch out the iliotibial band, known as the ITB.

These exercises for the knee can be done as part of your warm-up before a run or as a cool-down routine after a run, outside or indoors, or whenever is most convenient.

Typically, you should start to see some benefits after two weeks of doing these knee exercises every day.

You should not feel any pain when doing these exercises. If you do, stop immediately and seek medical advice. These exercises are not suitable for people with an existing knee injury.

 

Knee bends – 3 sets of 10 repetitions (reps)

 

Stand a foot away from a wall with your knees hip-width apart and your feet pointing slightly outwards. Slide your back down the wall by slowly bending your knees. Let the knees point in the same direction as your toes. As you come up, focus on tensing the teardrop muscle and your buttocks.

Tip: place a Swiss ball between your back and the wall for smooth movement

 

Thigh contraction – three sets of 15 seconds with each leg

 

Sit up straight on a chair. Slowly straighten and raise your right leg until straight with your foot pointing slightly outwards. Squeeze your right thigh muscles and hold this position for 10 seconds. For the exercise to be effective, you should keep tensing the teardrop muscle. Repeat with the other leg.

Tip: for more of a challenge, perform with an ankle weight

 

Straight leg raises – 3 sets of 10 reps with each leg

 

Sit up straight on a chair. Straighten and raise your right leg until straight, with your foot pointing slightly outwards. Keeping your leg raised, move your leg up and down while maintaining the contraction in the teardrop muscle. Repeat with the other leg.

Tip: for more of a challenge, perform with an ankle weight

 

Hamstring stretch with thigh contraction – 3 sets of 15 seconds with each leg

 

Sit on the edge of a chair. Keep your left leg bent and straighten your right leg, placing the right heel on the ground with your foot pointing slightly outwards. Bend towards your right leg to stretch your hamstring while tensing your teardrop muscle at the same time. 

Tip: keep your back straight and bend from the hips  you can do the move looking straight ahead or looking straight down

 

ITB (iliotibial band) – 3 sets of 15 seconds with each leg

 

To stretch your right ITB, cross your right leg behind your left leg. Keeping both feet on the ground, lean to your left side and push you right hip outwards. Don’t bend forwards or stick your buttocks out. You should feel the stretch along your outer right thigh and hip.

Tip: lean forwards onto a table to help with balance, or to increase the stretch 

 

Squats – three sets of 10 reps

 

Stand with your feet shoulder-width apart, feet pointing slightly outwards and your hands down by your sides or stretched out in front for extra balance. Lower yourself by bending your knees to no more than a right angle. Keep your back straight and don't let your knees go past your toes.

 

Single leg squat – 3 sets of 5 reps with each leg

 

Stand with both feet pointing forwards, hip-width apart. Lift your left foot off the ground and balance on your right foot. Now bend your right leg and slowly lower yourself, making sure your knee doesn’t go past your foot or lean inwards. Push back up slowly to your starting position.

Tip: if you can perform these with good form, you can progress on to the wide stance single leg squat

 

Wide stance single leg squat – 3 sets of 5 reps with each leg

 

Stand with your feet pointing slightly outwards. Shift your weight onto your right leg and lift your left foot off the ground. Now bend your right leg and slowly lower yourself, making sure your right knee points in the same direction as your right foot. Push back up slowly to your starting position, keeping your thigh and buttock muscles tight.

 

Lunges – three sets of 5 reps with each leg

 

Stand in a split stance with your right leg forward and left leg back. Slowly bend the knees, lowering into a lunge until the right leg is nearly at a right angle. Keeping the weight on your heels, push back up to the starting position. Keep your back straight and don't let your knees extend over your toes.

Tip: for more of a challenge, perform these lunges while walking

Content Supplied by NHS Choices

Wipe out winter tiredness

Do you find it harder to roll out of bed every morning when the temperature drops and the mornings are darker? If so, you’re not alone. Many people feel tired and sluggish during winter. Here are six energy-giving solutions.

What is winter tiredness?

If you find yourself longing for your warm, cozy bed more than usual during winter, blame the lack of sunlight.

As the days become shorter, your sleep and waking cycles become disrupted, leading to fatigue. Less sunlight means that your brain produces more of a hormone called melatonin, which makes you sleepy.

Because the release of this sleep hormone is linked to light and dark, when the sun sets earlier your body also wants to go to bed earlier – hence you may feel sleepy in the early evening.

While it’s normal for all of us to slow down generally over winter, sometimes lethargy can be a sign of more serious winter depression. This health condition, known medically as seasonal affective disorder, affects around one in 15 of us but can be treated. Read more about how to recognise winter depression. If your tiredness is severe and year-round, you could have chronic fatigue syndrome.

Try these tactics to boost your vitality during the winter months.

Sunlight is good for winter tiredness

Open your blinds or curtains as soon as you get up to let more sunlight into your home. And get outdoors in natural daylight as much as possible, even a brief lunchtime walk can be beneficial. Make your work and home environment as light and airy as possible.

Fight fatigue with vitamin D

The wane in sunshine over the winter months can mean you don’t get enough vitamin D, and that can make you feel tired.

The main source of vitamin D is sunlight, but here in the UK we can't make any vitamin D from winter daylight between November and March so it’s especially important to get vitamin D from your diet.

Good food sources of vitamin D are oily fish (for example salmon, mackerel and sardines), eggs and meat. Vitamin D is also added to all margarine, and to some breakfast cereals, soya products, dairy products and low-fat spreads.

Even with a healthy, balanced diet it’s possible to become vitamin D deficient. The government recommends that people at risk of vitamin D deficiency – including everyone 65 or over – should take a daily supplement.

Read more about how to get enough vitamin D and whether you may need a supplement.

Get a good night's sleep

When winter hits it’s tempting to go into hibernation mode, but that sleepy feeling you get in winter doesn’t mean you should snooze for longer. In fact if you do, chances are you’ll feel even more sluggish during the day.

We don’t technically need any more sleep in winter than in summer. Aim for about eight hours of shuteye a night and try to stick to a reliable sleep schedule. Go to bed and get up at the same time every day. And make sure your bedroom is conducive to sleep – clear the clutter, have comfortable and warm bedlinen and turn off the TV.

Read about how to get a good night’s sleep.

Fight winter tiredness with regular exercise 

Exercise may be the last thing you feel like doing on dark winter evenings, but you’ll feel more energetic if you get involved in some kind of physical activity every day, ideally so you reach the recommended goal of 150 minutes of exercise a week. Exercise in the late afternoon may help to reduce early evening fatigue, and also improve your sleep.

Winter is a great time to experiment with new and different kinds of activity. For instance, if you’re not used to doing exercise, book a session at one of the many open-air skating rinks that open during the winter. Skating is a good all-round exercise for beginners and aficionados alike. There are also many dry ski slopes and indoor snow centres in the UK, which will offer courses for beginners.

If you’re more active, go for a game of badminton at your local sports centre, or a game of 5-a-side football or tennis under the floodlights.

If you find it hard to get motivated to exercise in the chillier, darker months, focus on the positives – you’ll not only feel more energetic but stave off winter weight gain.

Read lots more tips for exercising in winter.

Learn to relax

Feeling time-squeezed to get everything done in the shorter daylight hours? It may be contributing to your tiredness. Stress has been shown to make you feel fatigued.

There’s no quick-fire cure for stress but there are some simple things you can do to alleviate it. So, if you feel under pressure for any reason, calm down with meditation, yoga, exercise and breathing exercises.

Find out more by checking out these 10 stress-busters.

Eat the right foods

Once the summer ends, there’s a temptation to ditch the salads and fill up on starchy foods such as pasta, potatoes and bread. You’ll have more energy, though, if you include plenty of fruit and vegetables in your comfort meals.

Winter vegetables such as carrots, parsnips, swede and turnips can be roasted, mashed or made into soup for a warming winter meal for the whole family. And classic stews and casseroles are great options if they’re made with lean meat and plenty of veg.

You may find your sweet tooth going into overdrive in the winter months, but try to avoid foods containing lots of sugar – it gives you a rush of energy but one that wears off quickly. Here are some quick and easy ways to cut down on sugar.

Find out more about energy-giving foods.

Now, read more articles on how to beat tiredness and fatigue.

Content Supplied by NHS Choices

How to run correctly

Running should be as easy as putting one foot in front of the other, right? Anyone can run, but having proper technique can make a huge difference.

Good running technique will help make your runs feel less tiring, reduce your risk of injury and ultimately be more enjoyable.

Mitchell Phillips, director of running experts StrideUK, shares his basic tips to help you run relaxed and efficiently.

Keep your head straight

Look straight ahead of you, about 30 to 40 metres out in front, and avoid looking down at your feet. Looking down will create tension in your neck and shoulders. Keep your jaw and neck relaxed.

Don't hunch your shoulders

Your shoulders should be back and down. Keep them relaxed and avoid tensing them. Don't hunch over as this restricts breathing, allowing less oxygen to get to the muscles.

Keep your hands relaxed

Your hands should be relaxed, but don’t let them flop. Tight hands can cause tension all the way up to the back and shoulders.

Keep your arms at 90 degrees

Your arms should be bent at a 90-degree angle. Try to swing them forward and back, not across your body. The arm movement helps to propel you forward, so swinging them sideways is a waste of energy.

Lean forward while running

Don’t bend forward or backward from the waist as this places pressure on the hips. Some experts advise running in an upright position, but Phillips believes using your body weight to lean forward a bit while running can reduce heel strike and help you land on the middle of your foot.

Keep your hips stable

Your hips should remain stable and forward-facing. Don’t stick your bottom out or rock your hips from side to side. Keeping this position in your hips can help prevent low back and hip pain.

Don't lift your knees too high

Land with a slight bend in the knee. This helps to absorb the impact of running on hard surfaces. Don’t lift your knees too high and avoid bouncing up and down. Your knees should be lifting forwards rather than upwards.

Aim for a mid-foot strike

Landing on the middle of your foot is the safest way to land for most recreational runners. Avoid striking the ground with your heel or your forefoot first. Your foot should land below your hips – not out in front of you.

Don't strike the ground heavily

Aim for short light steps. Good running is light and quiet. Whatever your weight, your feet should not slap loudly as they hit the ground. Light steps are more efficient and cause less stress to the body.

Breathe deeply and rhythmically

Whether you breathe through your nose or mouth, try to breathe deeply and rhythmically. Avoid shallow and quick breaths. Try to aim for one breath for every two strides, but don’t be afraid to try longer breathing.

Content Supplied by NHS Choices

David Weir, Paralympic superhuman

Paralympic superhero David Weir tried all manner of sports before falling for wheelchair racing. And the south Londoner, nicknamed the Weirwolf, says his sporting career might have been very different had he lived north of the Thames.

How are the arms?

I’m feeling OK actually. I was in great shape coming into the Games. My recovery has been pretty good. The arms aren’t aching too much. I’m just a bit tired. I’m still on a high after all I've achieved. I'm just really enjoying the moment.

How would you sum up your Games?

Fantastic! To win four gold medals at my home Games is special. Going into the Games, I didn’t want to put too much pressure on myself. I was aiming for one gold. I knew if I was to have a good Games, I needed to get a good start and the results would follow.

Were you surprised by the huge crowds?

I was surprised with the attendance in the stadium for the morning sessions. It gave us such a boost. I thought ticket sales would be good because Seb Coe and Locog had done a brilliant job of promoting London 2012 as one Games. To compete in front of so many people at your home Games was extraordinary.

Has the public's perception of the Paralympics changed?

The exposure Paralympians have had has massively surpassed my expectations. I’m honoured that on the front and the back pages Paralympic sport has got the recognition it should do. The Paralympics is no longer about disability. It’s about great athletes and great sporting events. People just want to see athletes performing at their very best. We’re superhumans and phenomenal athletes.

When did you get into sport?

I was born with something called a spinal cord transection. My spinal cord was severed. I’ve got some feeling in my lower half, but cannot lock my legs or stand up at all. I needed five operations just to straighten my feet.

My parents never treated me like I was disabled or different in any way. As a kid, I’d give anything a go. I was allowed to climb trees on the estate. I loved football and boxing but I couldn’t do them. I had to find something I could do in a chair. I got into wheelchair basketball but I didn’t get far because there weren’t any teams near me. All the good teams were in north London.

I remember watching the London Marathon wheelchair race and thinking: 'I want to try that'. I entered the London mini-marathon. I was eight. I didn’t have a racing wheelchair so I raced in a standard day chair. I think I impressed everyone, including myself, with how well I did. I'd found my sport. From that point on, there was no looking back.

Your first Paralympics weren't a success …

My first Games were in Atlanta in 1996. I went there as a 17-year-old expecting a wow factor but I didn’t get it. The event was poorly organised. There were long queues, the food was awful and the stadium was empty. I could count about five people in the crowd at times. It just ruined me. I fell out of love with the sport and when I got back I just didn't want to do it any more.

But you came back …

I was sitting on the sofa watching Tanni Grey-Thompson winning all her medals at the Sydney Paralympics in 2000. I regretted every minute of my four-year break from the sport. I wished I was there. I may have been in medal contention, you never know. That experience just drove me on. It renewed my desire to represent my country again and win gold medals.

What’s your training like?

The training we do is so hard, as demanding as any elite athlete in the world. When it’s freezing cold at the crack of dawn in the winter and you have to do 15 miles in Richmond Park, you feel it. It’s damp and your lungs are burning, you feel physically sick. The same can be true when it’s sweltering hot. Having said all that, I wouldn’t change it for the world.

You’ve been training with elite cyclists?

In the run-up to the Games, my coach Jenny Archer had me training with a group of high-level cyclists. They would take me through their gears on both flat and hilly terrain in Richmond Park at race speed. I credit that strategy for improving my speed and stamina by 20%-30%. In the space of 12 weeks, they’ve taken me up to another level I didn’t know I had in me.

What’s your advice on getting into disability sports?

Go and try every sport. There’s enough sports out there for someone with a disability to find something they enjoy. Don't think about what you can't do, think about what you can do. Enjoyment is the most important thing. Don’t get too serious too soon. If you find a sport you like, stick with it and take it from there.

  • To find out more about getting involved in disability sports visit the Parasport website.

What’s next for the 'Weirwolf'?

When you achieve something special, it’s hard not to reflect on the journey you’ve had. It still doesn’t seem that long ago I was doing trials for the London mini-marathon aged eight. I’m going to enjoy this moment for as long as I can and spend some time with my family. As for Rio 2016, I’m not thinking about that yet but I’ll probably have to make a decision by Christmas.

Content Supplied by NHS Choices

12 weight loss tips

Get off to the best possible start with these 12 diet and exercise tips to make your 12 weeks following the NHS Choices weight loss guide a success.

1. Don’t skip breakfast

Research shows that eating breakfast helps you control your weight. When you don't eat breakfast you may feel so hungry by lunchtime that you eat more food than usual, which cancels out the calories you saved by skipping breakfast. Check out five healthy breakfasts.

2. Eat regular meals

Some people think missing meals will help them lose weight, but it has been shown that eating regularly during the day helps to burn calories at a faster rate as well as reduce the temptation to snack on foods high in fat and sugar. Find out more about eating heathily.

3. Eat plenty of fruit and veg

Fruit and veg are low in calories and fat and high in fibre – three essential ingredients for successful weight loss. They also contain plenty of vitamins, minerals and antioxidants, essential to help you look and feel your best and to protect you from disease. Read up on getting your 5 A Day.

4. Get more active

Studies show that regular activity is key to losing weight and keeping it off. As well as providing numerous health benefits, exercise can help burn off the excess calories you can't cut through diet alone. Find an activity you enjoy and are able to fit into your routine.

5. Drink plenty of water

People sometimes confuse thirst with hunger. You can end up consuming extra calories when a glass of water is really what you need. You should aim to drink about six to eight glasses (1.2 litres) of fluid, preferably water, every day – or more if it’s warm or you’re exercising.

6. Eat high-fibre foods

Foods containing lots of fibre will keep you feeling full for longer, which is perfect for losing weight. Fibre is only found in food from plants, such as fruit and veg, oats, wholegrain bread, brown rice and pasta, beans, peas and lentils.

7. Read food labels

Knowing how to read food labels can help you choose healthier options, and keep a check on the amount of calories, fat, salt and added sugars you eat. Use the calorie information to work out how a particular food fits into your daily calorie allowance on the weight loss plan. Find out more about reading food labels.

8. Use a smaller plate

Studies show that people who use smaller plates tend to eat smaller portions and still be satisfied. By eating with smaller plates and bowls, you may be able to gradually get used to eating smaller portions without going hungry. It takes about 20 minutes for the stomach to tell the brain it’s full, so eat slowly and stop eating before you feel full.

9. Don’t ban foods

Don’t ban any foods from your weight loss plan, especially the ones you like. Banning foods will only make you crave them more. There’s no reason you can’t enjoy the occasional treat as long as you stay within your daily calorie allowance.

10. Clear out junk food

Clear your shelves of any junk food, such as chocolate, biscuits, crisps and sweet fizzy drinks to help you avoid temptation. Instead, stock up on healthy snacks, such as fruit, unsalted rice cakes, oat cakes, unsalted or unsweetened popcorn and fruit juice.

11. Cut down on alcohol

Most people would baulk at drinking a full glass of single cream, but wouldn’t think twice about the calorie content of a couple of pints of lager. However, the calorie content is similar and alcohol can easily contribute to weight gain. Find out more about calories in alcohol.

12. Plan your meals

Plan your breakfast, lunch, dinner and snacks for the week, making sure you stick to your calorie allowance. Try to plan for four to seven days’ worth of meals and snacks. Make a shopping list, but don’t shop when you’re hungry as that can lead to high-calorie impulse buys!

Content Supplied by NHS Choices

Rugby league: tackling mental wellbeing

There's going to be some nail-biting action on the rugby pitch this weekend in the round 27 matches to see who gets into the Super League play-offs, and the highs and lows on the pitch can be similar to the ups and downs in every fan’s life.

That’s why the Rugby Football League, Rugby League Cares, Sport Relief, Leeds Metropolitan University and the NHS Confederation are teaming up to tackle mental wellbeing this weekend.

You don’t have to have a mental illness to need some help with your mental wellbeing from time to time. We all go through good and bad periods in our lives – even rugby players will have an off day when they miss a tackle or give away a penalty.

Looking after your mental wellbeing is simply another way of thinking about ways to cope with the common difficulties life puts in your way. And if you learn to cope with the smaller problems in your life, it may help you to get some perspective on other issues.

There is evidence to suggest that five simple steps can improve our mental wellbeing. If you approach them with an open mind and try them, you can judge the results yourself. The steps are:

  • Connect. Connect with the people around you – your family, friends, colleagues and neighbours.
  • Be active. You don't have to go to the gym. Take a walk, go cycling or play a game of touch rugby. Find the activity that you enjoy and make it a part of your life.
  • Keep learning. Learning new skills can give you a sense of achievement and a new confidence. So why not sign up to start learning to play a musical instrument or figure out how to fix your bike?
  • Give to others. Even the smallest act can count, whether it’s a smile, a thank you or a kind word. Larger acts, such as volunteering at your kids’ rugby club, can make a big difference to your mental wellbeing.
  • Take notice. Be more aware of the present moment, including your feelings and thoughts, your body and the world around you. It can positively change the way you feel about life and how you approach challenges.

For more information on what is being done to help members of the rugby league family, visit the Rugby League Cares website or follow @rlcares on twitter.

 

Find out more about the five steps to mental wellbeing or try the mental wellbeing app below.

Content Supplied by NHS Choices

Start losing weight

Develop healthier eating habits and get more active with the NHS Choices Weight loss pack – a 12-week diet and exercise guide.

Weight loss pack features:

We want to help you adopt a healthier lifestyle so you can lose weight safely and learn the skills you need to keep it off in the long term.

Our plan puts you in the driving seat. You decide what to eat and drink. All you need to do is to stick to your daily calorie allowance.

The weight loss guide is designed to help you lose weight at a safe rate of 0.5kg to 1kg (1lb to 2lbs) each week by sticking to a daily calorie allowance. 

For most men, this will mean consuming no more
than 1,900 calories a day, and 1,400 calories for most women.

If you go over your limit one day, don’t worry, we've got that covered. It simply means you’ll have to reduce your calorie intake the following days.

For example, if you're a woman and you have 1,700 calories on Tuesday – that’s 300 calories more than your daily calorie allowance of 1,400 calories.

To stay on track, you’ll need to remove 300 calories from your remaining calorie allowance over the rest of the week.

Weight loss packs

The plan is delivered through 12 weekly weight loss packs full of weight loss resources, including weekly challenges to keep your journey fun and interesting.

Each printable weight loss pack contains a food and activity chart (view sample PDF, 4.92mb) to help you record your calories, exercise, and weight loss so you can see how well you're doing at a glance.

Print and stick the chart somewhere you can see it, such as the fridge or a kitchen cupboard and up-date it at the end of each day.

In addition to a healthy diet, regular physical activity is a vital component of your weight loss journey.

Not only will it help you lose more weight, but it will also keep you motivated while on the plan and improve your general health and well-being.

As you work through the weeks, you'll get lots of ideas and structured programmes to help you get active, from easy ways to gradually build activity into your day to the popular Couch to 5K5K+ and Strength and Flex podcast series.

Getting started

The links below provide the tools and knowledge you'll need from day one on the plan. Before you download week 1, its worth taking a look:

Download week 1 of the NHS Choices Weight loss pack.

 

*The NHS Choices Weight loss packs have been developed under the supervision and advice of specialist dietitians from the British Dietetic Association, which represents registered dietitians in the UK. Thanks to dietitians within DOM UK (Dietitians in Obesity Management) – a specialist group of the British Dietetic Association.

Content Supplied by NHS Choices

Start losing weight

Develop healthier eating habits and get more active with the NHS Choices Weight loss pack – a 12-week diet and exercise guide.

Weight loss pack features:

We want to help you adopt a healthier lifestyle so you can lose weight safely and learn the skills you need to keep it off in the long term.

Our plan puts you in the driving seat. You decide what to eat and drink. All you need to do is to stick to your daily calorie allowance.

The weight loss guide is designed to help you lose weight at a safe rate of 0.5kg to 1kg (1lb to 2lbs) each week by sticking to a daily calorie allowance. 

For most men, this will mean consuming no more
than 1,900 calories a day, and 1,400 calories for most women.

If you go over your limit one day, don’t worry, we've got that covered. It simply means you’ll have to reduce your calorie intake the following days.

For example, if you're a woman and you have 1,700 calories on Tuesday – that’s 300 calories more than your daily calorie allowance of 1,400 calories.

To stay on track, you’ll need to remove 300 calories from your remaining calorie allowance over the rest of the week.

Weight loss packs

The plan is delivered through 12 weekly weight loss packs full of weight loss resources, including weekly challenges to keep your journey fun and interesting.

Each printable weight loss pack contains a food and activity chart (view sample PDF, 4.92mb) to help you record your calories, exercise, and weight loss so you can see how well you're doing at a glance.

Print and stick the chart somewhere you can see it, such as the fridge or a kitchen cupboard and up-date it at the end of each day.

In addition to a healthy diet, regular physical activity is a vital component of your weight loss journey.

Not only will it help you lose more weight, but it will also keep you motivated while on the plan and improve your general health and well-being.

As you work through the weeks, you'll get lots of ideas and structured programmes to help you get active, from easy ways to gradually build activity into your day to the popular Couch to 5K5K+ and Strength and Flex podcast series.

Getting started

The links below provide the tools and knowledge you'll need from day one on the plan. Before you download week 1, its worth taking a look:

Download week 1 of the NHS Choices Weight loss pack.

 

*The NHS Choices Weight loss packs have been developed under the supervision and advice of specialist dietitians from the British Dietetic Association, which represents registered dietitians in the UK. Thanks to dietitians within DOM UK (Dietitians in Obesity Management) – a specialist group of the British Dietetic Association.

Content Supplied by NHS Choices

Start losing weight

Develop healthier eating habits and get more active with the NHS Choices Weight loss pack – a 12-week diet and exercise guide.

Weight loss pack features:

We want to help you adopt a healthier lifestyle so you can lose weight safely and learn the skills you need to keep it off in the long term.

Our plan puts you in the driving seat. You decide what to eat and drink. All you need to do is to stick to your daily calorie allowance.

The weight loss guide is designed to help you lose weight at a safe rate of 0.5kg to 1kg (1lb to 2lbs) each week by sticking to a daily calorie allowance. 

For most men, this will mean consuming no more
than 1,900 calories a day, and 1,400 calories for most women.

If you go over your limit one day, don’t worry, we've got that covered. It simply means you’ll have to reduce your calorie intake the following days.

For example, if you're a woman and you have 1,700 calories on Tuesday – that’s 300 calories more than your daily calorie allowance of 1,400 calories.

To stay on track, you’ll need to remove 300 calories from your remaining calorie allowance over the rest of the week.

Weight loss packs

The plan is delivered through 12 weekly weight loss packs full of weight loss resources, including weekly challenges to keep your journey fun and interesting.

Each printable weight loss pack contains a food and activity chart (view sample PDF, 4.92mb) to help you record your calories, exercise, and weight loss so you can see how well you're doing at a glance.

Print and stick the chart somewhere you can see it, such as the fridge or a kitchen cupboard and up-date it at the end of each day.

In addition to a healthy diet, regular physical activity is a vital component of your weight loss journey.

Not only will it help you lose more weight, but it will also keep you motivated while on the plan and improve your general health and well-being.

As you work through the weeks, you'll get lots of ideas and structured programmes to help you get active, from easy ways to gradually build activity into your day to the popular Couch to 5K5K+ and Strength and Flex podcast series.

Getting started

The links below provide the tools and knowledge you'll need from day one on the plan. Before you download week 1, its worth taking a look:

Download week 1 of the NHS Choices Weight loss pack.

 

*The NHS Choices Weight loss packs have been developed under the supervision and advice of specialist dietitians from the British Dietetic Association, which represents registered dietitians in the UK. Thanks to dietitians within DOM UK (Dietitians in Obesity Management) – a specialist group of the British Dietetic Association.

Content Supplied by NHS Choices

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