Fixcom 4® [tab]

Natrapharm [ Natrapharm ]
MIMS Class : Anti-TB Agents

See related Fixcom 4 tab information

Contents Rifampicin 150 mg, INH 75 mg, pyrazinamide 400 mg, ethambutol
275 mg
Indications Treatment of pulmonary & extra-pulmonary TB.
Dosage Patients weighing <55 kg 3 tab/day 55-70 kg 4 tab/day >70 kg 5
tab/day. Duration: 2 mth.
Administration Should be taken on an empty stomach (Take 1 hr before or 2 hr after
meals.).
Contraindications Rifampicin: Patients w/ jaundice. Pyrazinamide: Liver damage,
acute gout or hyperuricemia. Ethambutol: Optic neuritis.
Special Pregnancy & lactation. Rifampicin: Monitor liver functions & blood
Precautions count. Preexisting liver disease. W/draw therapy when
thrombocytopenia, purpura, hemolytic anemia or renal failure occur.
INH: Patients w/ convulsive disorders, history of psychosis, hepatic
or renal dysfunction. Patients at risk of neuropathy or pyridoxine
deficiency including diabetics, alcoholics, malnourished, uraemic,
pregnant or infected w/ HIV. Discontinue upon manifestation of
symptoms of hepatitis eg malaise, fatigue, anorexia & nausea &
elevated serum aspartate aminotransferase conc. Perform periodic
eye exam. Slow acetylator patients. Pyrazinamide: Patients w/ a
history of gout; impaired renal function. Increased difficulty in
controlling DM. Ethambutol: Patients w/ visual defects, elderly,
childn. Discontinue when visual disturbances arise. Reduce dosage
in patients w/ impaired kidney function.
Adverse Drug Rifampicin: Cutaneous syndrome, flu syndrome. GI disturbances &
Reactions bleeding, erosive gastritis. Ulcerative, eosinophilic &
pseudomembranous colitis. Transient liver function abnormalities,
hepatitis, thrombocytopenia, purpura, eosinophilia, leukopenia,
hemolytic anemia, renal failure, menstrual disturbances. Headache,
drowsiness, ataxia, dizziness, numbness, edema, myopathy,
muscular weakness. Orange-red discoloration of the urine & other
body fluids. INH: Peripheral neuritis, psychotic reactions &
convulsions, increase in liver enzymes, hepatitis, anemia,
agranulocytosis, thrombocytopenia, eosinophilia, skin eruption,
 fever, casculitis, nausea, vomiting, pellagra, purpura, hyperglycemia,
lupus-like syndrome, urinary retention & gynecomastia.
Pyrazinamide: Hepatotoxicity. Ethambutol: Retrolobular neuritis,
visual field constriction, central or peripheral scotoma, green-red
color blindedness. Confusion, disorientation, hallucination,
headache, dizziness, malaise, jaundice, transient liver function,
peripheral neuritis, thrombocytopenia, pulmonary infiltrates,
eosinophilia, GI disturbances. Hypersensitivity reactions.
Click to view ADR Monitoring Website
Drug Interactions Rifampicin: Antacids, anticholinergics, opioids, ketoconazole,
preparations containing bentonite. INH: Hepatotoxic drugs,
carbamazepine, ethosuximide, phenytoin, diazepam, triazolam,
chlorzoxazone, theophylline, enflurane, clofazimine, cycloserine,
warfarin, alcohol, Al-containing antacids. Pyrazinamide:
Probenecid.
Click here for more Interaction Checks
Storage For special storage condition to ensure optimal shelf-life of
medicine... click to view
Description For details on the chemical structure, and the excipient or inactive
compounds in the formulation... click to view
Mechanism of For Details of the mechanism of action, pharmacodynamics and
Action pharmacokinetics ... click to view
MIMS Class Anti-TB Agents
ATC J04AM06 - Rifampicin, pyrazinamide, ethambutol and isoniazid ;
Classification Belongs to the class of combination drugs used in the systemic
treatment of tuberculosis.
Pharmacokinetics: Rifampicin: Rifampicin is readily absorbed from the GIT and peak
plasma concentrations of about 7-10 mcg/mL have been reported 2-4 hrs after a dose of
600 mg, although there may be considerable interindividual variation. Food may reduce
and delay absorption. Rifampicin is approximately 80% bound to plasma proteins. It is
widely distributed in body tissues and fluids and diffusion into the CSF is increased when
the meninges are inflamed. Rifampicin crosses the placenta and is distributed into breast
milk. Half-lives for rifampicin have been reported to range initially from 2-5 hrs, the
longest elimination times occurring after the largest doses. However, as rifampicin
induces its own metabolism, elimination time may decrease by up to 40% during the first
2 weeks, resulting in half-lives of about 1-3 hrs. The half-life is prolonged in patients
with liver disease.

ymbicort® [turbuhaler]
AstraZeneca [ Zuellig ]
MIMS Class : Antiasthmatic & COPD Preparations
 
See related Symbicort turbuhaler information

Contents Budesonide, formoterol fumarate

Indications Regular treatment of asthma where use of a combination (inhaled
corticosteroid & long-acting β2-agonist) is appropriate. Symptomatic
treatment of patients w/ moderate or severe COPD, w/ significant
symptoms & a history of exacerbations.
Dosage Symbicort maintenance and reliever therapy (SMART): Per
80/4.5 mcg & 160/4.5 mcg Adult & adolescent ≥12 yr
Recommended dose: 2 inhalations/day or 1 inhalation bid.
Maintenance dose: 2 inhalations bid. Max: ≤6 inhalations Per 80/4.5
mcg Childn >4 yr Usual maintenance dose: 1 inhalation once daily.
Max ≤4 inhalations. Regular maintenance therapy: Per 320/9mcg
Adult >18 yr & adolescent 12-17 yr Recommended dose: 1
inhalation once or bid. Max: 2 inhalations bid. Per 80/4.5 mcg &
160/4.5 mcg Adult >18 yr & adolescent 12-17 yr 1-2 inhalations bid.
Max dose: 4 inhalations bid. Per 80/4.5 mcg Adult >18 yr &
adolescent 12-17 yr 1-2 inhalations once or bid. Max: 4 inhalations
bid, Childn >4 yr 1-2 inhalations bid. COPD Recommended dose:
Adult Per 320/9mcg 1 inhalation bid. Max: 2 inhalations daily. Per
160/4.5 mcg 2 inhalations bid. Max: 4 inhalations.
Overdosage For action to be taken in the event of accidental overdose ... click to
view
Contraindications Hypersensitivity to inhaled lactose.
Special Unstable or acute severe asthma. Patients who are transferred from
Precautions systemic to inhaled glucocorticosteroids. Thyrotoxicosis,CV
disorders, impaired adrenal function, growth suppression, DM,
untreated hypokalemia. Monitor growth of childn & adolescents on
long-term therapy. Pregnancy & lactation.
Adverse Drug Headache, palpitations, tremor, candida infections in the
Reactions oropharynx, mild throat irritation, coughing, hoarseness.
Click to view ADR Monitoring Website
Drug Interactions Ketoconazole, β-adrenergic blockers (including eye drops).
Click here for more Interaction Checks
Pregnancy
Category (US
FDA) Category C: Either studies in animals have revealed adverse effects
on the foetus (teratogenic or embryocidal or other) and there are no
controlled studies in women or studies in women and animals are
not available. Drugs should be given only if the potential benefit
justifies the potential risk to the foetus.
Caution For For caution against possible variation of physical aspect of
Usage medicine... click to view
Storage For special storage condition to ensure optimal shelf-life of
medicine... click to view
Description For details on the chemical structure, and the excipient or inactive
compounds in the formulation... click to view
Mechanism of For Details of the mechanism of action, pharmacodynamics and
Action pharmacokinetics ... click to view
MIMS Class Antiasthmatic & COPD Preparations
ATC R03AK07 - Formoterol and other drugs for obstructive airway
Classification diseases ; Belongs to the class of adrenergics and other inhalants
used in the treatment of obstructive airway diseases.
Poison Schedule Rx

Mechanism of Action: Symbicort contains formoterol and budesonide, which have

different modes of action and show additive effects in terms of reduction of asthma
exacerbations. The respective mechanisms of action of both drugs are discussed as
follows. The specific properties of budesonide and formoterol allow the combination to
be used both as maintenance and reliever therapy, and as maintenance treatment of
asthma. Budesonide: It is a glucocorticosteroid which when inhaled has a rapid (within
hours) and dose-dependent anti-inflammatory action in the airways, resulting in reduced
symptoms and fewer asthma exacerbations. Inhaled budesonide has less severe adverse
effects than systemic corticosteroids. The exact mechanism responsible for the anti-
inflammatory effect of glucocorticosteroids is unknown.

Fluimucil® [effervescent tab]

Zambon [ Cathay Drug ]
MIMS Class : Cough & Cold Preparations

See related Fluimucil effervescent tab information

Contents Acetylcysteine
Indications Acute & chronic resp tract affections w/ abundant mucus secretions.
Dosage Oral Adult 600 mg daily (preferably in the evening) or 200 mg bid-
tid. Childn 100 mg bid-qid according to age. Dissolve the tab or
content of sachet in a glass of water (75 mL). Inhalation soln
Nebulize 1 amp 1-2 times daily for ≥5-10 days. IM inj 1 amp 1-2
 times daily. Small childn ½ adult dose. IV Adult 1 amp bid up to 2-3
amp bid-tid. Childn 1-1½ amp bid-tid. It is recommended to dilute
IV inj w/ 0.9% NaCl soln or a 5% glucose soln.
Administration Should be taken with food
Contraindications Effervescent tab/Sachet Phenylketonurics.
Special
Asthmatic patients. Patients w/ history of peptic ulceration.
Precautions
Adverse Drug Rarely, urticaria, bronchospasm, nausea, vomiting. Aerosol
Reactions treatment: Rhinitis, stomatitis.
Click to view ADR Monitoring Website
Pregnancy
Category (US
FDA) Category B: Either animal-reproduction studies have not
demonstrated a foetal risk but there are no controlled studies in
pregnant women or animal-reproduction studies have shown an
adverse effect (other than a decrease in fertility) that was not
confirmed in controlled studies in women in the 1st trimester (and
there is no evidence of a risk in later trimesters).
MIMS Class Cough & Cold Preparations
ATC R05CB01 - Acetylcysteine ; Belongs to the class of mucolytics.
Classification Used in the treatment of wet cough.

Floxel® [vial]
UAP [ United Lab ]
MIMS Class : Quinolones
  

See related Floxel vial information

Contents Levofloxacin
Indications Treatment of adults ≥18 yr w/ mild, moderate & severe infections
caused by susceptible strains of microorganisms in the following
conditions: Community-acquired pneumonia, acute bacterial
exacerbation of chronic bronchitis, acute maxillary sinusitis,
complicated & uncomplicated skin & skin structure infections, acute
pyelonephritis, complicated & uncomplicated UTI, nosocomial
pneumonia, chronic bacterial prostatitis.
Dosage Adult Tab 250-500 mg once daily. IV 500 mg administered by slow
infusion over 60 min every 24 hr or 750 mg administered by slow
infusion over 90 min every 24 hr. 750-mg tab Acute bacterial
sinusitis, community-aquired pneumonia 750 mg for 5 days.
Nosocomial pneumonia, complicated skin & skin structure
infection 750 mg for 7-14 days.
Overdosage For action to be taken in the event of accidental overdose ... click to
view
Contraindications Hypersensitivity to quinolones. IV Epilepsy, history of tendon
disorders related to fluoroquinolone therapy. Childn, pregnancy &
lactation.
Special Patients should be adequately hydrated. History of convulsive
Precautions diseases eg epilepsy & those w/ renal insufficiency. Discontinue if
CNS stimulation eg tremors, hallucinations, paranoia, depression
occur. Hypersensitivity. Pregnancy, lactation & childn <18 yr.
Adverse Drug Diarrhea, abdominal discomfort, nausea, anorexia, abdominal pain,
Reactions vomiting, stomatitis & heartburn; insomnia, headache & dizziness;
rash, pruritus & eczema; muscle & joint pain; bone marrow
depression. Increased liver enzymes. Pain, reddening at the inj site,
phlebitis.
Click to view ADR Monitoring Website
Drug Interactions Antacids, sucralfate, metal cations & multivit prep containing Zn
may interfere w/ absorption. Concomitant administration of
theophylline, fenbufen or similar NSAID may increase the risk of
CNS stimulation & convulsive seizures. Disturbances of blood
glucose reported in patients treated concomitantly w/ quinolones &
an antidiabetic agent. IV Do not co-administer w/ soln containing
multivalent cations eg Mg through the same IV line. Warfarin.
Click here for more Interaction Checks
Pregnancy Contraindicated in 1st trimester.
Category (US
FDA)
Category C: Either studies in animals have revealed adverse effects
on the foetus (teratogenic or embryocidal or other) and there are no
controlled studies in women or studies in women and animals are
not available. Drugs should be given only if the potential benefit
justifies the potential risk to the foetus.
Storage For special storage condition to ensure optimal shelf-life of
medicine... click to view
Description For details on the chemical structure, and the excipient or inactive
compounds in the formulation... click to view
Mechanism of For Details of the mechanism of action, pharmacodynamics and
pharmacokinetics ... click to view
Action
MIMS Class Quinolones
ATC J01MA12 - Levofloxacin ; Belongs to the class of fluoroquinolones.
Classification Used in the systemic treatment of infections.
Poison Schedule Rx
Pharmacology: Pharmacodynamics: Levofloxacin is the levorotatory isomer of
ofloxacin which inhibits DNA topoisomerase, more commonly referred to as the DNA
gyrase. DNA gyrase is necessary for bacterial DNA replication and some aspects of
transcription, repair, recombination and transposition. Inhibition of DNA gyrase in
susceptible microorganisms results in the inhibition of ATP-dependent negative
supercoiling of DNA, inhibition of ATP-independent relaxation of supercoiled DNA and
promotion of double-stranded DNA breakage resulting in bacterial cell death.

lacidipine
MIMS Class : Calcium Antagonists
See available brands of lacidipine

See related lacidipine information

Indication HTN.
Dosage PO Initial: 2 mg once daily, up to 4-6 mg/day if needed.
Click to view Dosage by Indications
Administration May be taken with or without food.
Contraindications Within 1 mth of MI, cardiogenic shock, unstable angina, aortic
stenosis.
Special Conduction abnormalities, congenital or acquired QT prolongation,
Precautions poor cardiac reserve. Hepatic impairment. Pregnancy and lactation.
Adverse Drug Headache, flushing, oedema, dizziness, palpitations, aggravation of
Reactions angina, increased alkaline phosphatase. Rarely asthenia, rash (e.g.
erythema and itching), gastric upset, nausea, gum hyperplasia,
polyuria, muscle cramps, mood disturbances.
Drug Interactions Additive hypotensive effect with other antihypertensives (e.g.
diuretics, β-blockers, ACE inhibitors). Increased plasma
concentration with cimetidine. Elimination and metabolism may be
altered by potent CYP3A4 inhibitors and inducers.
Potentially Fatal: Increased risk of ventricular arrhythmias with
drugs that prolong QT interval (e.g. class I and III antiarrhythmics,
 TCAs, certain antipsychotics, antibiotics and antihistamines).
Click to view more Drug Interactions
Food Interaction For caution against potential drug-food interactions ... click to view
Storage For special storage condition to ensure optimal shelf-life of
medicine... click to view
Mechanism of For details of the mechanism of action, pharmacology and
Action pharmacokinetics and toxicology ... click to view
MIMS Class Calcium Antagonists
ATC C08CA09 - lacidipine; Belongs to the class of selective
Classification dihydropyridine derivative calcium-channel blockers with mainly
vascular effects. Used in the treatment of cardiovascular diseases.
Lacidipine is a potent dihydropyridine calcium antagonist mainly selective for calcium
channels in the vascular smooth muscle. It dilates peripheral arterioles resulting in
reduced peripheral vascular resistance and blood pressure.
Absorption: Rapidly but poorly absorbed from the GIT (oral).
Distribution: Protein-binding: >95%
Metabolism: Extensive first-pass metabolism.
Excretion: In the bile via faeces (70%, as metabolites), via urine (remaining dose); 13-19
hr (elimination half-life).

Product Description
Filled with ready-to-use lesson plans and proven activity ideas, this book explains how to
effectively and safely deliver the health-related exercise (HRE) component of the
National Curriculum for England and Wales.

Experienced physical education teachers Jo Harris and Jill Elbourn have played a key
role in the success of the health-related exercise movement in Britain. Their in-service
courses and resource materials have helped teachers recognise the need for HRE and
learn how to teach it. In Teaching Health-Related Exercise at Key Stages 1 and 2, they
share a variety of ways in which HRE can be organised and delivered within the
curriculum, enabling teachers to determine which methods of delivery are most
appropriate for their pupils.

Teaching Health-Related Exercise at Key Stages 1 and 2 translates National Curriculum

theory into practice and links its physical education and health education requirements.
Covering everything from planning to assessment, this indispensable guide

• addresses safety considerations for children`s exercise;

• examines successful programmes that schools have adopted for promoting exercise
among their pupils;
• presents ideas that use simple, readily available equipment;
• provides detailed lesson examples that address the key issues of progression,
differentiation and assessment and
• describes 19 practical activities that can be incorporated into health-related PE lessons.

Comprehensive and easy to understand, this resource gives teachers everything they need
to promote active lifestyles through the primary curriculum.
Physical exercise is any bodily activity that enhances or maintains physical fitness and
overall health. It is performed for many different reasons. These include strengthening
muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance
and for enjoyment. Frequent and regular physical exercise boosts the immune system,
and helps prevent the "diseases of affluence" such as heart disease, cardiovascular
disease, Type 2 diabetes and obesity.[1][2] It also improves mental health, helps prevent
depression, helps to promote or maintain positive self-esteem, and can even augment an
individual's sex appeal or body image.[3] Childhood obesity is a growing global concern[4]
and physical exercise may help decrease the effects of childhood obesity in developed
countries.

Classification
[edit] Types of exercise

Exercises are generally grouped into three types depending on the overall effect they
have on the human body:

Flexibility exercises, such as stretching, improve the range of motion of muscles
and joints.[5]

Aerobic exercises, such as cycling, swimming, walking, rowing, running, hiking
or playing tennis, focus on increasing cardiovascular endurance.[6]

Anaerobic exercises, such as weight training, functional training or sprinting,
increase short-term muscle strength.[7]

[edit] Categories of physical exercise

 Strength training
 Agility training

Sometimes the terms 'dynamic' and 'static' are used. 'Dynamic' exercises such as steady
running, tend to produce a lowering of the diastolic blood pressure during exercise, due to
the improved blood flow. Conversely, static exercise (such as weight-lifting) can cause
the systolic pressure to rise significantly (during the exercise).
[edit] Benefits

A common elliptical training machine.

US Marines exercising on the USS Bataan.

Physical exercise is important for maintaining physical fitness and can contribute
positively to maintaining a healthy weight, building and maintaining healthy bone
density, muscle strength, and joint mobility, promoting physiological well-being,
reducing surgical risks, and strengthening the immune system.

Exercise also reduces levels of cortisol. Cortisol is a stress hormone that builds fat in the
abdominal region, making weight loss difficult.[citation needed] Cortisol causes many health
problems, both physical and mental.[8]

Frequent and regular aerobic exercise has been shown to help prevent or treat serious and
life-threatening chronic conditions such as high blood pressure, obesity, heart disease,
Type 2 diabetes, insomnia, and depression.[9] Endurance exercise before meals lowers
blood glucose more than the same exercise after meals.[10]

There is some evidence that vigorous exercise (90-95% of VO2 Max) is more beneficial
than moderate exercise (40 to 70% of VO2 Max).[11] Some studies have shown that
vigorous exercise executed by healthy individuals can increase opioid peptides (a.k.a.
endorphins, naturally occurring opioids that in conjunction with other neurotransmitters
are responsible for exercise-induced euphoria and have been shown to be addictive),
increase testosterone and growth hormone,[12] effects that are not as fully realized with
moderate exercise. More recent research[13][14] indicates that anandamide may play a
greater role than endorphins in "runner's high".

Both aerobic and anaerobic exercise also work to increase the mechanical efficiency of
the heart by increasing cardiac volume (aerobic exercise), or myocardial thickness
(strength training). Such changes are generally beneficial and healthy if they occur in
response to exercise.

Not everyone benefits equally from exercise. There is tremendous variation in individual
response to training: where most people will see a moderate increase in endurance from
aerobic exercise, some individuals will as much as double their oxygen uptake, while
others can never augment endurance.[15][16] Similarly, only a minority of people will show
significant muscle growth after prolonged weight training, while a larger fraction
experience improvements in strength.[17] This genetic variation in improvement from
training is one of the key physiological differences between elite athletes and the larger
population.[18][19] Studies have shown that exercising in middle age leads to better physical
ability later in life.[20]

[edit] Effect on the cardiovascular system

The effect of exercise on the cardiovascular system is well documented.

There is a direct relation between physical inactivity and cardiovascular mortality, and
physical inactivity is an independent risk factor for the development of coronary artery
disease. There is a dose-response relation between the amount of exercise performed
from approximately 700 to 2000 kcal of energy expenditure per week and all-cause
mortality and cardiovascular disease mortality in middle-aged and elderly populations.
The greatest potential for reduced mortality is in the sedentary who become moderately
active. Most beneficial effects of physical activity on cardiovascular disease mortality can
be attained through moderate-intensity activity (40% to 60% of maximal oxygen uptake,
depending on age). ... persons who modify their behavior after myocardial infarction to
include regular exercise have improved rates of survival. ... Persons who remain
sedentary have the highest risk for all-cause and cardiovascular disease mortality. [1]

[edit] Effect on the immune system

Although there have been hundreds of studies on exercise and the immune system, there
is little direct evidence on its connection to illness. Epidemiological evidence suggests
that moderate exercise has a beneficial effect on the human immune system while
extreme exercise impairs it, an effect which is modeled in a J curve. Moderate exercise
has been associated with a 29% decreased incidence of upper respiratory tract infections
(URTI), but studies of marathon runners found that their prolonged high-intensity
exercise was associated with an increased risk of an infection, although another study did
not find the effect. Immune cell functions are impaired following acute sessions of
prolonged, high-intensity exercise, and some studies have found that athletes are at a
higher risk for infections. The immune systems of athletes and nonathletes are generally
similar. Athletes may have slightly elevated natural killer cell count and cytolytic action,
but these are unlikely to be clinically significant.[21]

Vitamin C supplementation has been associated with lower URTIs in marathon runners.
[21]

Biomarkers of inflammation such as C-reactive protein, which are associated with

chronic diseases, are reduced in active individuals relative to sedentary individuals, and
the positive effects of exercise may be due to its anti-inflammatory effects. The
depression in the immune system following acute bouts of exercise may be one of the
mechanisms for this anti-inflammatory effect.[21]

[edit] Effects on brain function

A 2008 review of cognitive enrichment therapies (strategies to slow or reverse cognitive

decline) concluded that "physical activity, and aerobic exercise in particular, enhances
older adults’ cognitive function".[22]

In rats, exercise improves cognitive functioning via improvement of hippocampus-

dependent spatial learning, and enhancement of synaptic plasticity and neurogenesis.[23]
In addition, physical activity has been shown to be neuroprotective in many
neurodegenerative and neuromuscular diseases.[24] For instance, it reduces the risk of
developing dementia.[25] Furthermore, anecdotal evidence suggests that frequent exercise
may reverse alcohol-induced brain damage.[26]

Why is exercise good for the brain? There are several possibilities:

increasing the blood and oxygen flow to the brain

increasing growth factors that help create new nerve cells[27] and promote synaptic
plasticity[28]

increasing chemicals in the brain that help cognition, such as dopamine,
glutamate, norepinephrine, and serotonin[29]

Physical activity is thought to have other beneficial effects related to cognition as it

increases levels of nerve growth factors, which support the survival and growth of a
number of neuronal cells.[30]

[edit] Effects on depression

A number of factors may contribute to depression including being overweight, low self-
esteem, stress and anxiety.[31] Endorphins act as a natural pain reliever and antidepressant
in the body.[citation needed] Endorphins have long been regarded as responsible for what is
known as "runner's high", a euphoric feeling a person receives from intense physical
exertion.[32] However, recent research[13][14] indicates that anandamide may possibly play a
greater role than endorphins in "runner's high". When a person exercises, levels of both
circulating serotonin and endorphins are increased.[33] These levels are known to stay
elevated even several days after exercise is discontinued, possibly contributing to
improvement in mood, increased self-esteem, and weight management.[32] Exercise alone
is a potential prevention method and/or treatment for mild forms of depression.[34]

Exercise also affects the sleep that a person will receive at night. When the body is
physically exhausted it will slip into Rapid Eye Movement (REM) sleep easier and for a
longer period.[35][32]

Nutrition and recovery

Proper nutrition is as important to health as exercise. When exercising, it becomes even

more important to have a good diet to ensure that the body has the correct ratio of
macronutrients whilst providing ample micronutrients, in order to aid the body with the
recovery process following strenuous exercise.[44]

Proper rest and recovery are also as important to health as exercise; otherwise the body
exists in a permanently injured state and will not improve or adapt adequately to the
exercise. Hence, it is important to remember to allow adequate recovery between exercise
sessions. It is necessary to refill the glycogen stores in the skeletal muscles and liver.
After exercise, there is a 30 minute window critical to muscle recovery. Before doing
anything else, one should drink something for recovery. Liquids are ideal after exercise
and there are several studies that show low-fat milk and chocolate milk as being effective
recovery beverages because of its ideal 4:1 combination of carbohydrate and protein that
fuels and replenishes our muscles the best.[45][46] Branched-chain amino acids are also
recommended for exercise recovery.[citation needed]

The above two factors can be compromised by psychological compulsions (eating

disorders such as exercise bulimia, anorexia, and other bulimias), misinformation, a lack
of organization, or a lack of motivation. These all lead to a decreased state of health.

Delayed onset muscle soreness can occur after any kind of exercise, particularly if the
body is in an unconditioned state relative to that exercise.[47]