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Obesity - Muscular Exercise of Other Kinds

heart, fat, apparatus, time and methods

OBESITY - MUSCULAR EXERCISE OF OTHER KINDS.

Muscular work without the advantage of adapting it rigorously to each particular case, may of course be prescribed in various other ways, but all methods aiming at this are inferior to walking and climbing at special health resorts (Terrain Curorte). They are most admissible in those cases in which a visit to these health resorts, or walking and climbing exercise is not practicable for one reason or another. I have pointed out elsewhere the insufficiency of Swedish gymnastics by figuring out the greatest decomposition of fat in the time set down for these exercises based upon observations upon forced muscular work (Pettenkofer and Voit). Practical expe rience in using these methods agrees perfectly with the computa tions which have been made. The decomposition of fat which is thus accomplished is too insignificant and insufficient when we consider what an immense amount of fat has to be clone away with. The results are better from the working .machines (Gaertner's ergostat). The apparatus consists in a turning wheel which is balanced by a weight fixed to a lever and which offers resistance to efforts at turning according to the weight attached. The motion of the apparatus de pends upon the position the patient assumes while working it. When disturbances in the circulation and respiration are present, such as heart insufficiency, stasis in the venous system, as is the case in obesity with fatty heart, especially in the anemic and hy clrmic class of cases, the slightest upward pressure upon the heart and lungs will cause dyspncea, making it impossible to employ the apparatus without injury to the patient. Even if the latter as

sumes different positions from time to time, which according to Gaertner must correspond to the various phases of respiration, it will make no difference in the result. The apparatus can only be used in the first stages of the plethoric form if the heart is still intact.

The same limitations concern likewise other methods of work, such as sawing and splitting wood, rough games, dumb-bell gymnas tics, etc. These can only be used in cases where the heart is still capable of normal effort, and where dilatation of the heart from ex cessive work is not to be dreaded. This concerns again cases of plethora in the first stages of obesity, but even here the work done must be under the constant supervision of the physician, and the pa tients must never be lost sight of for too long a period, since just when treatment is being most efficacious, if a rapid decrease of fat takes place, over-exertion of the heart may easily occur. In this con nection I want to call attention to the fact that by increasing muscu lar activity alone without suitable diet (Binge), fat reduction is not readily brought about (Bauting), and in those cases where neverthe less an occasional effect has been observed, it was after all due to a diminished ingestion of fat-forming substances and the burning up of the stored body-fat, factors which may have escaped observation.