有病可不可以去運動？ (by 林杏青醫師)
之前在台中有一名44歲男子健身時感到身體不舒服，場館方也很快叫來救護車，但最後還是不治死亡。不知這個新聞是否讓你有點擔心？
擔心週末陪家中長輩出去慢跑、游泳是否會出狀況；擔心上個月大病初癒的兒子是否能經得起校隊高強度的訓練；擔心自己曾經腳踝嚴重扭傷，現在還能和兄弟們去打籃球嗎？
今天林杏青醫師要來和大家聊聊：有病就要吃藥，不是，有病能不能運動？
運動對身體很好，大方向來說，我們希望每個人只要動得起來就多運動，不只健康的人要動一動，不健康的人動一動也會比單純吃藥還要好。
美國運動醫學會建議一般18至65歲的人每週中等強度運動五次，每次三十分鐘；或是用一半的時間來做高等強度運動。中等強度的意思是運動時身體能量消耗是休息時的3~6倍，例如騎腳踏車半小時之類的；而高強度運動是指能量消耗是休息時的6倍以上，例如跟人尬游泳之類的。
(不用想也知道我們大部分的人都麻沒有達到建議的量，哭哭)
運動與心血管負荷
現在問題來了，運動之所以能夠為我們的身體帶來好處，其中一個原因是增加身體的負荷，例如運動中心跳變快，可以鍛鍊你的心臟；跑跳時骨頭承受壓力，可以讓骨頭好壯壯；提升血液循環可以加速新陳代謝。
但是….增加負荷的同時也意味著運動過程中增加風險？！
什麼意思呢？
假如你心臟不好，當你運動時心跳加快，就會比平常更有可能ㄘㄨㄚˋ掉；假如你骨質疏鬆，那你跑來跑去跳來跳去的時候，就更有可能摔斷手腳；假如你平常都不運動，肌肉很軟嫩，跟和牛一樣，突然激烈運動會比較容易受傷。
「所以我到底要動還是不要動？你搞得我好亂啊！！」
有病當然可以運動呀！！
只是需要更謹慎一點，你需要先了解自己的身體狀況，適合做什麼樣的運動？以及做到什麼程度？如果你有教練的話，一定要讓教練了解你每次運動的狀態、感受，還有以前的疾病史、健康史。
假如你不確定，那也可以請醫生幫你評估。雖然說醫生看診都很忙，你可能會有點不好意思，但是這樣才能避免你未來成為他的病患呀。建議不需要去找醫院裡的醫生，可以去找診所裡的醫生，同時也做到醫療資源分流。
那什麼樣的人在運動前需要先找醫生評估？
主要是有心血管疾病、慢性病相關問題的人會比較需要。這裡有加拿大做的評量表格(連結在此)，非常可惜的他是英文版，而且他有版權所以我們不能直接翻成中文給大家下載，所以這裡只先翻譯第一部分，比較一般性的檢查項目：
- 曾經有醫生說你心臟不好？或心臟有問題？或是血壓過高？
- 你曾經在日常生活中休息時感到胸痛？或是在運動時胸痛過？
- 你在過去一年內曾經感覺到暈眩或失去平衡或是失去意識嗎？
- 你曾經被診斷出心臟與血壓以外的慢性病嗎？
- 你正在吃處方簽的藥或是慢性病的藥嗎？
- 你現在，或在一年內，有過骨頭、肌肉、韌帶、肌腱、關節或其他軟組織的問題，而運動可能使那些問題變得更嚴重嗎？
- 醫生曾經說過你只能做醫學規範內的某些運動？
如果你上面都回答沒有，恭喜你，你是好棒棒的健康寶寶，運動出代誌的風險極低，可以放心的去跑跳。
如果上述有任何一題的答案是「有」，那就建議找醫生評估。另外，第一部分的表格也保守的提到幾件事：如果你超過45歲而且沒有中或高強度運動的習慣，想要越級打怪的話還是找專業人士幫忙會比較安全；如果你最近感冒或是狀況不好，建議等身體好了再進行運動；如果你是孕婦，需要用別的表格來評估。
雖然基於版權我們沒有把第二部分的表格翻譯出來，但大略提一下。第二部分主要是針對肌肉、骨骼、癌症、高血壓、心血管疾病、慢性病、新陳代謝、精神狀況、呼吸系統、脊椎、神經、中風等項目做更詳細的提問，因為這些都會增加你運動時的風險。
另一個問卷是美國 ACSM (American College of Sports Medicine) 和 AHM (American Heart Association) 所做的表格：
- 是否曾經心臟病發作？心臟動過手術？心律不整？冠狀動脈心導管手術？之類的心血管病史
- 是不是曾經胸部不舒服？沒原因的喘不過氣？暈眩或昏倒？這些健康歷史
- 有沒有糖尿病？或是肺部的疾病？
- 曾經走一點路就抽筋？有沒有過肌肉骨骼的問題來影響或限制你的運動？
- 你是孕婦嗎？或是其他令你擔憂運動會狀況的事情？
他還會問一些有點尷尬的問題XD 例如：
- 你是不是超過45歲的？簡稱中年大叔
- 妳是不是超過55歲而且停經或是切除過子宮？翻成白話就是歐巴桑
- 有沒有抽菸？或是戒菸還不超過六個月？
- 高血壓？或是在吃高血壓的藥？或是你根本不知道自己的血壓靠？
- 你是不是膽固醇很高？或是你根本不知道自己膽固醇多少？
- 你的近親中有沒有人還沒超過55歲就有心血管問題？
- 你是不是不常運動？(每週運動不超過三次，每次不超過30分鐘)
如果你對以上問題認同感很高(兩項以上)，這份表單就會認為你需要一些專業評估。
運動是好的，但自己的健康絕對不能隨便，一個好壯壯的大漢，要是不幸腦出血也有可能變成好痛痛手無縛雞之力的半癱復健男；一個好壯壯的女漢子，一個不幸可能心肌梗塞腦缺氧變成躺在床上沒有意識的白菜。如果有任何潛在相關疾病，建議還是先看醫師然後接受運動專業人士的指導比較好，不要想說「不會啦，哪有那麼衰。」通常會說這種話的都是最衰的那一個。
同時也要注意你的教練是否有合格的證書，運動場館有沒有AED等急救設備，防火以及逃生設備是否合格。
另外不建議把運動都安排在週末，這種週末戰士運動傷害風險會比較高，原因是運動間隔時間太長，你的身體沒有跟著變強，然後因為太久沒動很容易想要一次多動一點比較划算，結果就受傷了。也不建議每週提高運動強度超過10%，這樣會大幅增加運動受傷的風險，依照身體狀態循序漸進才是好的！
延伸閱讀：
合作撰寫：
幫助你找復健科診所、骨科診所、物理治療所、運動教練的搜尋器 (點這裡)
註：本部落格文章是以科普、衛教為出發點，不代表任何人的生理狀況。每個人的身體皆不相同，有任何疑問請詢問自己的醫師、物理治療師、專業教練。
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