Sarcopenia

We have all heard about osteoporosis or weakening of bones as we age. Many of us have done bone density tests and are taking supplements to prevent or treat osteoporosis. But what is sarcopenia? Sarcopenia is a loss of muscle mass that occurs as we age. As we mature into adults, hormonal changes ensure optimal muscle mass by the age of 25. But this muscle doesn’t remain constant with us throughout life. For those who lead a sedentary lifestyle, muscle loss starts as early as at the age of 30. Typically an inactive person loses up to 5% of muscle mass per decade.

What happens when we lose muscle? First and foremost a weak muscle offers poor protection to its neighbouring joint. Joints need strong muscles to function properly and durably for many years. When muscles are weak, the joints become vulnerable to damage. This damage can happen in any joint, but typically it is seen in the knee joint, the neck and the lower back. Initially patients complain of only occasional pain. Painful joints are instinctively rested by the patient. The rest worsens sarcopenia. This in turn predisposes the joint to even more damage. Thus the pain sets up a vicious cycle. This cycle ends in osteoarthritis of the knee or spondylitis of the neck or back, which in its last stages requires surgical treatment. 

Loss of muscle also results in a lower basal metabolic rate (BMR). In simple words, the body is unable to burn calories efficiently. Lower BMR combined with a modern high calorie diet leads to increase in body fat. Excess fat increases insulin resistance. The end result is central obesity or a pot belly with diabetes, coronary heart disease (heart attack) and hypertension (high blood pressure).

End stage sarcopenia which occurs in elderly patients results in frailty, loss of balance & frequent falls. Sarcopenia is thus responsible for not only musculo-skeletal problems like osteoarthritis and fractures but also life style illness' like diabetes.

Is sarcopenia preventable or treatable? The good news is that it is! We can slow down the loss of muscle that happens with age by making positive changes in our diet and lifestyle. If we work a muscle, it will respond by a tear - repair mechanism to become stronger and a stronger muscle means a reversal of sarcopenia. The best way to strengthen a muscle is by doing resistance training. This can be done by either lifting weights like dumbbells or by using our own body weight. Typical body weight exercises are squats, push ups and lunges. As sarcopenia affects all muscle groups, it is important to work out all muscle groups. We must exercise not only thigh and calf muscles but also chest, back, upper limb and abdominal muscles. Walking is not a good exercise for sarcopenia as it works out only leg muscles and it is not a resistance training exercise.

Diet is as important in the prevention of sarcopenia. For muscles to repair and become stronger they need protein as a raw material. Protein is essential in a healthy diet. We must ensure adequate protein intake. A normal adult requires 0•8 gm of protein per kilo of body weight per day. Meat, eggs and dairy products are rich sources of protein. Roasted, boiled or baked chicken or fish are the healthiest source of meat protein. Milk, cheese and yogurt are good dairy sources. Vegetarian sources of protein include beans, lentils, green peas, chickpeas, soy, spinach, asparagus and brocolli. Nuts like almonds and peanuts also contain protein. Fruits can also provide protein with the richest sources being guavas, berries and apricots. To be effective, a high protein diet must go hand in hand with a low carbohydrate, low sugar and low fat diet.

A lot of research is going on but there still is no medicine that can stop or reverse sarcopenia. Exercise and diet remain the key to prevention as well as cure. We must eat clean and exercise hard to remain healthy and keep illness at bay. We really have no choice!

Which exercise is best for weight loss?

We now know that obesity is a problem. The pot belly is a house of disease. Obesity and high blood pressure go hand in hand. So do obesity and diabetes and obesity and coronary heart disease (chest pain and heart attack). Losing weight is the need of the hour. Weight loss is no more a goal for mere good looks. It is essential if one wants to lead a healthy life.

Diet is the key to weight loss. I have written on diet and weight loss, the pot belly and the evils of sugar. For some people, diet alone may not be enough. Their basal metabolic rate (B.M.R) is so low that changes in food habits are not enough to bring about the weight loss. In simple words they are just not burning enough calories. The fat burning engines of their body have gone to sleep. Exercise is the only way to increase their metabolic rate.

All of us think of walking when we are considering exercise. We feel it is the best exercise to do the job. In fact it is the first exercise that comes to our mind. Many of us have taken up walking only to give it up after a few months or weeks. Many of us have stuck to walking for years. But how many have really succeeded in losing weight by walking alone? Probably very few. All our life we have been brain washed by health experts, doctors and dieticians into thinking that walking is the best exercise. Gyms spend crores on treadmills and have entire sections dedicated to cardio. Those who can walk are encouraged to jog and even run. Marathons have evolved from a sporting competition to the new health fashion! But alas, all this is far from the truth!

Walking is not the best exercise to lose weight. Walking falls in the category of what experts call 'steady state cardio'. Walking is a basic life function and the body has evolved over the years to make it very energy efficient. So not enough muscle groups get involved when we walk. If we walk for longer distances then the muscles quickly adapt and become more energy efficient. A similar process happens when one jogs or runs at a constant pace. That's why we feel tired or get palpitations (can feel our heart beating) only for a few of the initial walks. After a week or so of walking, we can walk the same distance with ease. An energy efficient muscle will conserve calories and not burn them! However for patients with existing heart problems, walking remains a good exercise. They require an exercise that will put less strain on the heart. Heart patients should not try any other exercise without consulting their physician.

Which are then the best exercises to lose weight? To lose weight we must increase our metabolic rate. That will happen when large groups of muscles work hard. To achieve this we must do the opposite of steady state cardio. It is called High Intensity Interval Training (HIIT). As the name suggests periods of high intensity workouts should alternate with short intervals of rest. If you choose to exercise on a treadmill, then short bursts of brisk walking should alternate with short periods of walking slowly. People who are more fit, can do bursts of sprinting alternating with intervals of slow jogging. A similar interval training can be done in cycling and swimming. These short bursts require the muscles to work hard. By pushing the muscles out of their comfort zone we can force them to become calorie hungry. Metabolic rate and calorie burn is thereby increased.

Another way to lose weight efficiently is by weight training. By lifting weights we can exercise large muscles of the body and the exercise is not restricted to only a few muscle groups. The entire body musculature gets involved. Furthermore by pushing the muscles to their limits, there is a tremendous increase in calorie burn which lasts throughout the day as the muscles recover. We can thus achieve a sustained rise in metabolic rate. Weight training is perhaps the most efficient way to increase metabolism. 

Boot Camp exercises or Body Weight training is an alternative for those who cannot join a gym. These are sets of exercises which make use of the body weight instead of dumbbells and machines. Examples of such exercises include squats, dips, lunges and burpees. Quick sets of such exercises performed with short breaks are effective in achieving a higher metabolic rate.

Losing weight is all about diet for most of us. Both quality and quantity is important. For some people changes in diet are not enough. They need to fire up their metabolic engines to burn up those calories. Age old beliefs of types of food which increase weight, have recently been proven to be wrong. Similarly its time for a paradigm shift in our ideas about exercise. The words cholesterol and walking have now been replaced by sugar and HIIT!

The Pot Belly - a sign of prosperity ..... think again!

It's customary in India to see a man with a pot belly/paunch and say "it's a sign of prosperity". The origins of this comment are deep routed. Weight loss is associated with illness. Weight gain is associated with newly acquired wealth and hence access to richer foods. In addition a typical Indian mother is obsessed with feeding her children. A rolly-polly child seems to bring immense satisfaction to his/her mother. She feels she is doing her job well. This obsession continues even when the children become adults. If an adult male loses weight it is assumed that his wife/mother is not looking after him. To his/her friends and family, a person's pot belly is accepted easily. It's hardly a matter of concern! It's to be joked about and forgotten. 

The truth couldn't be further from this. The pot belly is the root cause of all health issues today. It's literally a house of disease. It will bring in its wake horrendous illness' like blood pressure, diabetes and the dreaded coronary heart disease (heart attack).  It is a measure of a persons lack of physical fitness. People with pot bellies are more prone to back pain (lumbar spondylitis) and knee pain (osteoarthritis). It is also a direct indicator of a persons unhealthy eating habits. 

Pot bellies were not so common until recently. Why didn't our ancestors have a pot belly? What are we doing wrong? Our fore-fathers did a lot of physical activity. No access to vehicles meant they were walking a lot. No elevator meant they were climbing stairs. They were lifting their own bags. They were using cycles and not motor-cycles. They had to walk to the market to buy their vegetables, walk to pay their bills and walk to the bank. With the progress in technology, mobile phones and internet, we are doing everything from the comfort of our home or office. The result is a near complete lack of physical activity. That is not all. There is a change in diet patterns. Our fore-fathers ate natural and home made food. Going to a hotel to eat food was not even a monthly event let alone every week or every day. There were no fancy bakery products like cakes, biscuits, toasts, etc etc. There was no packaged food industry and therefore no (or less) chocolates, sweets, ice creams, colas, chips, chevda, mad angles, etc etc. As a result, people in those days did hard physical work and ate healthy food. So it comes as no surprise that in today's day and age, the pot belly is common and so are lifestyle illness' like diabetes etc. 

The new age brought with it a food evolution. Sugar became the new mantra. Adding sugar made food tasty and easier to sell. As a result packaged food items associated with with wealth like chocolates and colas were packed with sugar. In fact most packaged food items contain sugar. May it be a seemingly harmless biscuit or apparently healthy cornflakes. This kind of sugar is hidden and we don't know about it till we read the ingredients. Only recently research has shown a direct correlation with sugar intake and obesity. 

Now it becomes clear ..... A paunch is truly a sign of prosperity as only the wealthy can indulge in these expensive packaged sugar products. And the whole food and advertising industry wants you to spend money on these food stuffs. The newspaper is full of the adverts and so is the television. Gullible people like us are falling prey. They are doing exactly what the adverts tell them to do. Biscuits, jams, chocolates have become part of our lifestyle. We cannot imagine a world without them. 

We need to wake up and realise how foolish we have been. We need to go back to the ways of our ancestors. We need to say no to the cola and yes to a walk. We need to look down on our pot belly and get rid of it immediately. We need to caution our friends and relatives and inspire them to get rid of theirs. A pot belly is a recipe for disaster and no trivial joking matter. 

It is now time for a paradigm shift. Exercise must not be seen as an optional leisure activity that you do if you have spare time. It's a necessary task of daily routine like eating a meal or having a bath. Similarly food must not be viewed as ‘going on a diet to lose weight’ but a healthy, natural (low sugar, low oil) eating habit must be developed as a permanent lifestyle change. 

Self Preservation

How often have we seen a personal crisis ruining life? A young man just managing to settle down in life suffers a heart attack! He now faces a prolonged recovery and loses his job. Medical expenses coupled with a loss of income push him into a financial crisis. A young woman juggling her job and family life suffers an accident. A slow recovery means she cannot look after her children. All of us dread a personal crisis but what do we do to prevent it? We must think about self preservation. We must take precautions to avert a potential crisis!


An accident is top on the list. Accidents can occur in a variety of places. They can occur on the road, at home, at work or when travelling. The most common and the most dreaded are road accidents. The road conditions in many developing countries are pathetic and accidents occur rampantly. Yet I see few people thinking about prevention. Wearing a helmet is a simple basic precaution which will save a person from a potentially lethal or paralysing head injury. It is the difference between getting up and walking away from an accident versus an injury which may  lead to permanent disability and handicap if not death. The same applies to wearing a seat belt in a car. Seemingly simple, easy and effective precautions and yet many of us don't do it! Why? Because we don't think about life preservation untill it's too late. Following road rules (like using an indicator or not cutting lanes), avoiding rash driving and speeding, stopping at signals, keeping the vehicle well maintained and regularly serviced go a long way in accident prevention. Talking on the phone while riding a bike or driving a car is another recipe for a catastrophe! What about accidents at home? In the kitchen, be careful with the cooking gas! Old malfunctioning pressure cookers can burst, hurriedly used sharp knives can cut fingers and hot utensils and boiling oil/water can burn. The other danger zone at home is the bathroom. Make sure the bathroom floor is non slippery. There should be support handles for old people to get up. Beware of sharp shelf edges which could injure if one falls.  Don't climb on a chair to reach for a high shelf or clean the fan, use a stable ladder. The same rules apply for the work place or when travelling. We must be extra careful when travelling. An accident in a foreign land can be particularly nasty as we are helpless and often end up with less than ideal medical care.


The next is a medical crisis. We cannot control all the factors that lead to illness! But we can definitely control some of them. Young people get so busy with work and family that they don't have time for health preservation. The modern motto is to work hard now and enjoy the fruits after retirement. But reality is quite the opposite. By the time they retire,  people are bogged down with so many medical problems that their old age is nothing more than suffering, pain, doctors visits and a long list of medicines. Little does one realise that the efforts to achieve a healthy old age need to start when one is young. The idea of an investment which will pay returns in the future appeals to all but they are unable to apply the same logic to health. And yet, the truth is that investing in health remains the most profitable proposition. What factors can one control? Most critical is to stay away from addicting substances like cigarettes, alcohol, tobacco and drugs. These substances guarantee a life of suffering and a miserable old age. Beyond that, a healthy lifestyle boils down to two main factors - diet and exercise. I have written a number of articles on diet and exercise. Interested readers can access them on my blog - www.orthindia.blogspot.com. A good diet is about good quality foodstuffs and portion control. We must educate ourselves about which food is good for us. We ought to consume more protein and fibre (vegetables and fruits) and less carbohydrates and fats. We need to differentiate between good carbohydrates (chapati) versus not so good carbohydrates (rice) versus bad carbohydrates (potato, bread, maida, cake, jam, biscuits, cold drinks, sugar, mithai, ice cream, bakery products, chocolates and sweets). Stay away from bad carbohydrates. They are poor quality foodstuff. Portion control remains the key to weight reduction. Amount of food to be consumed in each meal should be decided before we start to eat. Eat only small amounts of food for lunch and dinner and compensate by having healthy snacks in between. A heavy meal neutralises the benefit achieved from a long period of starvation or a session of exercise. We must eat slowly to feel satiety with seemingly small quantities of food. Make it a habit to read the ingredients label on food packets to look for hidden sugar. As a thumb rule, food cooked at home will always be healthier than eating out. Be careful when eating outdoors or when travelling as chances of ending up with an upset tummy and loose motions are high. For exercise, do activities that you enjoy! There are no set rules. Choices are plenty from walking, running, cycling, swimming, aerobics, going to the gym or doing yoga. Remember that the only bad workout is the one that didn't happen. Aim to do some exercise for at least half hour, 5 times a week. Ideally one needs to exercise for an hour every day. Today people lead stressful lives, eat poorly, avoid exercise and buy medical insurance. The smart choice would be to work towards health and not ever need insurance.
The last aspect of illness prevention is timely screening for silent diseases and treatment of medical problems. Problems like blood pressure, diabetes and heart disease may not result in any symptoms for many years. An early diagnosis is crucial for preventing permanent damage. So everyone must get themselves screened for these illness' on a regular basis. It does not end with screening. One needs to to take proper treatment of his/her illness. For hypertensive patients, blood pressure should be controlled. For diabetes, blood sugars should be controlled. A diabetic patient must own a home blood sugar testing machine and must check blood sugars every week. Timely and regular intake of medicine coupled with regular testing and doctor's follow up is essential. 


A mention must be made here about the weekend warrior. These are the people who indulge in contact sports like football only on the weekends. Such sports require a high level of physical fitness which can come only with vigorous daily exercise. Those who don't exercise have weak muscles which offer poor protection to the joints. Hence the weekend warrior is much more prone to injury to the shoulder, wrist, knee or ankle than the physically fit person. Those who don't exercise daily are better off avoiding weekend sports.


Self preservation is an awareness that must be cultivated in the mind. A constant vigil will reduce the chances of a potential tragedy. Simply put it is the difference between happiness and suffering. The choice is really ours to make. Is it worth riding a bike for thrills or spending all your time at work or gorging on meals till your shirt buttons pop? We ought to rely on ourselves to look after our health rather than medical insurance ...... prevention will always remain better than cure!!

Exercise Update: Too Much Too Fast

Time and again we are inspired to exercise. It may be due to motivation from a family member or a friend. It may be after seeing someone successfully lose a lot of weight. It may be the result of a warning given by a doctor. It may be due to a sudden surge of self motivation or enthusiasm. And when we finally start exercising, we land up having pain and discomfort. Sometimes the pain is bad enough to force us to stop exercise. The conclusions reached by people who face this situation are always interesting! 'Exercise does not suit me!', 'Exercise will damage my joints!', 'The doctor is bad!', 'Exercise is not a treatment, I need a proper treatment!' etc. Are these conclusions justified? Can exercise be harmful? 

Yes, there are conditions in which certain exercises can prove to be harmful. A classic example is of a patient with a bad heart who is advised not to exert or walk. Another scenario is a post operative setting after surgery where the doctor will caution against certain exercises. But these situations are rare. And for these patients, the treating physician will be very firm and specific in his advice not to do certain activities or exercise. But for the majority of us who are in average, if not good health, exercise can do little harm. 

I have seen many people cleverly use this situation to their advantage! These are the ones who do not want to exercise and understandably so … exercise requires a lot of effort and can be very boring. Besides the results achieved from exercise are never instant! So by saying 'exercise does not suit me' they manage a quick and easy escape from doing exercise .... and concerned relatives stop bothering them! 

So why do some of us experience pain and discomfort after exercise? To understand this we need to understand the nature of our muscles. Our muscles are high maintenance tissues. I say this because of the following reason. When we work our muscles, they will become larger and stronger. The more we work our muscles, the stronger they become. The strength and endurance of our muscles is directly proportional to how much we exercise them. This is easy to understand. The trouble happens when we stop exercising. The strength of muscles falls drastically when exercise is discontinued. And this fall is always quick. It doesn't matter if a person has exercised for one month or one year or ten years. If he/she stops exercising, everything is lost in a matter of a few months. Now lets consider an example. A person has toiled in the gym for ten years. He has a well toned and muscular body. He has a set routine that he is following religiously. He then takes a break for 6 months. He does not do any exercise. After 6 months he returns to the gym. In his mind he is still a fit person as he remembers the efforts he has put in for ten years.  So he starts following the same routine he was accustomed to. But his muscles are now much weaker than he realises. As a result he does more than his muscles can handle. The result is pain, discomfort and potential injury. He has made the mistake which most people make of doing too much too fast! Similarly, consider a person who doesn't exercise. He has decided to start exercising. He is excited and motivated about exercising. He ends up making the same mistake. The enthusiasm drives him to do too much too fast. The result is again pain, discomfort and potential injury. 

So what is the solution? Once we understand the nature of our muscles, the solution is obvious! When exercising we need to start slowly. Time spent on a treadmill, speed of walking, everything should be very less. Similarly number of exercises done and number of repetitions should be minimum. A person should feel like he has done nothing in the initial sessions of exercise. If he experiences pain or discomfort, he should realise he is doing too much, too fast. He should aim to find a level of exercise so low that he feels no pain. Once that level of exercise is understood, then that level must be maintained for a sufficient number of days. All increments in exercise must be small and many days apart. The second crucial step is to do an adequate warm up before starting the actual exercise. In a warm up the muscle groups are stretched repeatedly so the muscle gets toned up. A stretched and warmed up muscle is far less likely to get pulled or otherwise injured during an exercise session. In this way one can exercise without pain or injury and can enjoy the experience of exercising and gain the benefits as well. 

So the next time you experience pain after a session of exercise, do not be discouraged. Don't reach absurd conclusions like 'exercise is harmful for me?' Do not stop exercising. Understand that you are probably doing too much too fast. With this new understanding, you can get back to exercising without pain! 

Let's Look Around Us!

Let’s look around us. People are becoming ill! It's the curse of the modern times. Technology has improved and mankind has made progress. But this progress has had an adverse impact on health.
Let’s take food for example. To become successful, the business of food has to run on the sole basis of taste. That which tastes good sells. So, all technology is used to make tasty food, even if this is at the risk of making it unhealthy. Let’s look around us. Walk into a mini market and see what is up for display. Biscuits? - Extremely unhealthy snack made of sugar! Cakes? - Unhealthy! Jams? - Unhealthy! Papads and pickles? - Unhealthy! Instant noodles? - Unhealthy! Colas and ice creams? - Unhealthy! Chips? - Unhealthy! Chocolates and candies? - Unhealthy! What is common in all these food products? They taste good. So what do we do? We buy these and feed it to our children! Unbelievable but true... We take the unhealthiest of foods and give it to the people that matter most to us! Then what is the surprise when these children go on to become very ill as adults?
Let’s look around us? When attending a marriage, what is talked about the most? It's the food! The success of a marriage function is based solely on how tasty the food is? The richer the food (in oil and unhealthy ingredients) the more appreciated is the function. The motto is "more the merrier". So maximum points go to the meal that had the most starters. Fried foods get a thumbs up. Then what is the surprise when a young man gets a heart attack?
Let’s look around us? What is the most happening thing now in the restaurant business? Buffets and Buffets with unlimited starters. Some buffets have 5 varieties of starters and some have 7 or even more! And after the starters are done with you have to eat the main course which you have to walk 5 - 10 metres just to look at. And if that is not enough, there is separate counter for a variety of deserts! We feel proud of ourselves that we managed to eat so much more at a low price. Little do we realise that we have actually paid to get ourselves harmed and damaged.
Let’s look around us? Fast foods - aren't they awesome? May it be Chinese or pizzas or burgers? Think about it. Bread made of Maida, butter, fried patties, lots of cheese, mayonnaise, MSG etc. Doesn't sound too awesome to me!
Aren't we consuming too much? If not too much in quantity, too bad in quality?

So let’s see where we spend this excessively accumulated energy? Let’s look around us. It’s the beauty of modern technology. We live in apartments that have lifts. We travel in cars or bikes or public transport. We sit or stand and work. All work is done from one place.  So business is conducted on the cell phone. Bills are paid sitting at home. All banking is done without actually going to a bank. Groceries, vegetables, food stuffs and medicine are delivered home.  Exercise? Gym? Morning walk? Yoga? We don't have time for these luxuries! We are too busy earning money! We are so busy that we haven't stopped to find out how much money is enough! When we finish earning, then we will concentrate on fitness! Little do we realise that by the time we finishing earning, it's too late. By then we are spending our earnings more on doctors and less on enjoyment.

We have seen the impact of technology on food and exercise. Now let’s see its impact on other aspects of health. Let’s look around us. People are stressed. The stress of a job! Deadlines, pushy bosses, financial commitments and competition. The stress of family! Duties towards parents, harmony with one’s spouse and time for children. The stress of achievement and success! Becoming rich, becoming famous or becoming both. Stress, stress and some more stress. No wonder diseases like blood pressure, diabetes and coronary heart disease are on the rise.

What about orthopaedic problems? Let’s look around us. Once again we have technology to thank! Sitting on a chair and working on a computer for hours together to earn a living! Or standing for hours together in a factory! Or travelling for 50-60kms every day on a bike or driving a car! Add to that a poor diet, lack of exercise and stress and I assure you that you will get plenty of orthopaedic problems.

So friends, let’s stop and look around us. What are we eating? How much are we eating? Do we need to eat as much as we are eating? Can we eat healthier? Are we spending the calories we are consuming? Are we exercising enough? Is it worth taking out the time for fitness? Why are we stressed? Do we really need to earn more and where do we need to draw the line? Is family important? If yes are we giving enough time to our families? Are we really living or just going through the motions like robots?

Let’s prevent technology from ruining our lives!

The Ultimate Vaccine

We all know about vaccines. A vaccine is any preparation used to confer immunity against a specific disease.  It’s an amazing discovery of medical science and a very appealing concept indeed. You take the vaccine and you will be protected from the illness forever. As soon as a new born baby is born, parents are rushing to the doctor to get him/her vaccinated.

Wouldn’t it be wonderful if there was a vaccine for blood pressure or diabetes? Or a vaccine for knee arthritis or spondylitis?

What if I tell you that there is such a vaccine? And it’s not a new invention. It’s been around for some time. And better still, it’s free! Would you believe me?

Believe it or not, it’s true. Such a vaccine does exist! .... Unfortunately we have forgotten about it. This vaccine is EXERCISE!

Imagine that you have just bought a new expensive car or jewellery that you have been wanting for a long time. You will look after it well. The car will be cleaned and serviced regularly. The jewellery will be kept carefully in a box. Your body is a gift from God! Close your eyes and ask yourself, have you been good to your body? Have you looked after it? If you don’t maintain your car, it will give you trouble. It won’t run properly. But still most people will look after their cars far better than they will care about their own bodies. A bad car is an inconvenience, but a bad body means suffering!!

A healthy body is crucial to be able to enjoy life. All the money in the world is a waste, when you don’t have health. Without health, you cannot enjoy your new car or house or your vacation. And at times it is too late. You cannot even buy health. So how do you vaccinate your body against disease? How do you look after this beautiful gift?

Prevention is better than cure. If you don’t want to suffer with ill health and disease, you have to act now. Physical fitness with exercise is the best way to avoid lifestyle related illnesses like blood pressure, heart disease and diabetes. And it only works if you do exercise regularly throughout life.

As young people we get busy with work. We want to work hard so that we earn and secure our future. Many of us get obsessed with work. We lose track of priorities and we lose perspective. What is the point of working so hard and abusing your body? You may or may not end up becoming very rich, but you definitely will end up with a lot of illnesses. So all the hard earned money is then spent to become better and many times in spite of the money spent, you remain ill.

So my sincere request to young people is to not lose the wonderful days of their youth in work. Everything should be in moderation which is true also for work. Work is important and everyone has to work but draw your limits. The human body is not designed to work 24/7. Earn a little less but enjoy it by remaining healthy. Extra money earned is useless as it is at the cost of health.

What type of exercise should we do? There are three basic types of exercise. The most important exercise is aerobic exercise. Aerobic exercise is any activity that increases your heart rate (you can hear and feel your heart beating fast) and your breathing rate (panting). Regular aerobic exercise is the best vaccine against lifestyle disorders. Everybody cannot do aerobic exercise. Especially if you are a heart patient, you need to check with your doctor before starting aerobic exercises. Those who are not accustomed to aerobic exercise should start slowly. Eventually one should increase to the recommended 30 to 40 minutes of aerobic exercise daily. Some examples of aerobic exercise are brisk walking, jogging, running, cycling, swimming and rowing. Aerobic exercises have become famous as ‘cardio’ exercises in modern gyms. While doing exercise, it is important to remember to go to the next level of difficulty, just like a student progresses to the next grade or standard in school. Cycling is a safe exercise for those suffering from knee pain.

The next exercise is Yoga or stretching exercises. These exercises are good for the health of joints and they are a vaccine for arthritis and spondylitis. Yoga exercises ensure that all joints move through their complete natural range of motion.

The third type of exercise is individual muscle strengthening exercises. These are exercises which ‘body builders’ do. Strong muscles protect joints from damage. Most people do not need to use weights. Anti gravity muscle endurance exercises are sufficient.

Many patients ask me if yoga is enough. All three types of exercises are important. So yoga on its own is not enough. Yoga will complement aerobic exercise to give you a better result.

Many patients tell me that they are working in the office or the kitchen all day and that is enough exercise! Physical work is better than sleeping in bed but it is poor exercise. Work generally results in exertion and exhaustion rather than exercise. Those who exercise regularly develop enough stamina so they can work harder, faster and more efficiently without getting tired.

Moreover exercise comes with pleasant side effects! People who exercise feel a sense of pride and satisfaction like the proud owner of a new diamond set. This translates into a positive energy in their daily lives. So they work better, they maintain better relations with their loved ones and they are more happy.

If you are one of the people who says ‘I don’t have the time for exercise’ then I feel sorry for you. If there is time to eat, if there is time to sleep, if there is time to pray, if there is time to watch television or read a newspaper then there can be time for exercise. It is a question of priority and commitment.’ Where there is a will there is a way’  

The worst enemy of exercise is laziness. It is an enemy of many things. There is no glory in laziness. We have to fight this enemy in every living moment of our lives!

So my dear readers, if you want the gift of good health then you have to work for it. Get up and get going and grab that vaccine!

Update (11/04/2020)-

I had written this way back in 2012. Today the world is being threatened with the COVID19 pandemic. People are looking for immunity boosters. It’s not going to improve with some magical pill or supplement. My experience has taught me that exercise is crucial to build immunity to fight infections. It’s the disciplined people who pay attention to their nutrition and who exercise regularly that have the best chance to beat the corona virus!

In a review published in 2019 (Journal of Sport and Health Science 8 (2019) 201À217 - The compelling link between physical activity and the body’s defense system. David C. Nieman, Laurel M. Wentz), the authors concluded

With near daily exercise, the changes to the bodies white blood cells enhance immune defense activity and metabolic health.

Studies consistently support the inverse relationship between moderate exercise training and incidence of URTI. These data led to the development of the J-curve model that links URTI risk with the exercise workload continuum. Several studies also suggest that regular physical activity is associated with decreased mortality and incidence rates for influenza and pneumonia.

Regular exercise training has an overall anti-inflammatory influence mediated through multiple pathways. Studies consistently show decreased levels of inflammatory biomarkers in adults with higher levels of physical activity and fitness.

There is increasing evidence that the circulation surge in cells of the immune system with each exercise bout and the anti-inflammatory and antioxidant effect of exercise training have a summation effect over time in modulating tumorigenesis, atherosclerosis, and other disease processes

Immunosenescence is defined as immune dysregulation with aging. Emergent data support that habitual exercise is capable of improving regulation of the immune system and
delaying the onset of immunosenescence.

The Obesity Factor

Obesity

Obesity is a big problem. To start with it kills self esteem. You don't feel good about yourself. There is a constant feeling of guilt. You don't look attractive. Your clothes don't fit well. You are embarrassed of your weight and what people may think of you.

Some feel, you shouldn't bother about what people say. Maybe they are right. But wouldn't it be awesome of you could shed that fat?

Apart from being a social issue, obesity is a much bigger medical problem.

The obese are more likely to suffer from hypertension (high BP), diabetes and ischaemic heart disease (heart attack). They are prone to get lumbar spondylitis and knee arthritis. In summary, obese will live shorter lives and that life will have more suffering.

So those who say "I live to eat" or "I love food", I'd like to warn them that they will pay a heavy price for their indulgence.

If you are still not interested in loosing weight, you don't need to read further! I say this because loosing weight is not simple or easy. It is a Herculean task, nothing less than a complicated project that needs your full concentration till completion.

First step is to rule out medical illness. Many disorders for eg thyroid problems lead to weight gain. It is only logical to address these medical issues before trying to lose weight.

You can lose weight by diet AND exercise. Even a small child will tell you that. What is important to realise is diet alone or exercise alone may not be enough. So diet has to go hand in hand with exercise.

Which diet?
There are many diets out there that guarantee weight loss. Each claiming to be better than the other. They all work! It's common sense. If you starve you will loose weight. The issue here is how long can you sustain a diet? The more fancy and effective the diet the less likely it is for you to stick to it. And once you are off the diet, all your weight is back in a few months. So how do you approach the problem?
I feel your diet should not change drastically. Obviously less oil, less salt, less sweet! More importantly less quantity. We have been brought up to think that it is nothing less than a crime to stop eating before your stomach is overfull. We need to loose that habit. We have to train ourselves to get up from the meal with a hungry stomach. It takes a lot of effort and determination to do this.
Just one useful tip. Usually dinner is the heaviest meal for most people. I believe that if you can attack this one meal consistently you can achieve your goal. One way is to eat of bowl of fruits and raw vegetable salad one hour before dinner. That way your tummy is full and you can easily avoid a heavy dinner.

Which exercise?
To loose weight you need aerobic exercise. This means any exercise that increases your heart rate (you can hear your heart beating) and your breathing rate. For eg brisk walking, jogging, swimming, cycling, rowing etc. The recommendation is to do aerobic exercise for half hour everyday.

Many people are not able to loose weight. Some of them genuinely cannot loose weight and they need medical attention. But most of them fail cos they fall short in effort. Loosing weight is a full time job that needs a high level of sincerity and commitment. Commitment so that you don't give up and sincerity so that you don't take short cuts. The biggest enemy of those who don't loose weight is usually laziness!

To conclude, obesity is not only a social problem, it is more serious medical issue. Loosing weight is essential. With determination and motivation, most people can shed their fat. Two proverbs come to mind - "where there is a will, there is a way" and "try try till you succeed"

YOU CAN BECOME THIN!!

Feedback on 'Physical fitness is free...for smart people'

This is some of the feedback I got on - Physical fitness is free...for smart people.

Mark Says

Exercise isn't totally free.

If you're going to run, you have to buy a good pair of running shoes, and if you want to take up cycling, I recommend you buy a good bike.

Don't skimp on those items. If you do, you'll regret it in the end, and won't get the benefit you expect.

But you're right about one thing, all it takes is time, and no matter what you may choose to believe, there is plenty of time available. But even more importantly, you have to stay motivated, and setting a goal will help with that.

During my 25 years as a competitive cyclist (at the local level), I have found there is nothing easier to accomplish, then to invent an excuse not to train. It may seem difficult to overcome at times, but I know from experience, that I'll regret it even more afterwards, if I give in to the temptation.

Vreni Gurd says

Resistance training outside a gym

Cardiovascular exercise is easy to do outside a gym setting and is far more pleasurable. Resistance training is a bit tougher because it takes some know-how and imagination, but there is a lot one can do with very little. Body-weight exercises like squats, lunges, push-ups, pull-ups work well, and if a small investment is made into a Swiss Ball (about $50) a whole world of resistance and stretch exercises become possible. Tubing is also very inexpensive and is a good way to add resistance exercise to a workout.

To progress, do more repetitions, do the exercise more slowly and with impeccable control, or make the exercise less stable. This won't give you a bodybuilder's physique, but it will tone you up, and get you in decent shape. And if the resistance routine is set up well, it can be a great cardiovascular workout too! To get the know-how (the power is in the details!), there are good books on the subject, but it may actually be worth hiring a personal trainer or conditioning specialist for an hour to ensure that the exercises are done correctly. Small investment compared to a gym membership.

But Orthindia and Marc are right. The commitment is about time, not money! And it sure is easy to find an excuse not to exercise!

I spend hours in a gym everyday helping others improve their health through exercise and find it tough to motivate myself to stay after the work-day is over to train myself. So, like Marc suggested, I've set a goal. Next October, I'm hiking the Grand Canyon, so I better be able to handle a 50lb pack on my back for 6-8 hours a day hiking both down and up a fairly steep slope. Much of my training for this trip will be outside in the BC mountains, which will be far more pleasurable than being stuck in a gym! I can't wait!

Vreni Gurd

Health and Vitality Coach
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca

Physical fitness is free...for smart people

At some point all of us have had the temptation to join a gym. A friend tells you about a cool gym he has joined or you read an add in the papers. The gym has impressive stuff like sophisticated machines, training programs, weight loss guarantees, etc. You have not been exercising of late, so the idea of getting into shape appeals to you.

So you decide and go and get yourself enrolled. They offer you a program for a year, convincing you that it is the best deal and will save you a lot of money. You think to yourself - 'If I enroll for a year, it will be an incentive to keep going because I've paid so much money! Besides this is such a good bargain!' The deal is struck and your money is gone.

And you start going to the gym. Initially the enthusiasm is high. You are enjoying yourself and you don't skip a day. A month goes by. The daily routine is getting tougher, the exercise sessions longer and boring. The pinch you felt in your pocket is becoming a distant memory. You skip a day. You start getting distracted, and now you are going alternate days.

2 months pass by, you haven't been to the gym in a week. You make yourself go the next day.

A year has passed by. You have forgotten about the gym. So many people get themselves into this situation everyday, month and year.

Yes there are people who go the whole year and for many years after that. I congratulate them on their commitment. This post is not for them. It is also not for those committed to body building. This is for people like me - the lazy who dream that someday they will get into shape. And believe me, we are in the majority.

My message is simple. Don't waste your hard earned money on a gym. Hey! wait a minute. I'm not telling you not to exercise. Hear me out.

Physical fitness is not an investment of money. It is an investment of time. No gym, however cool, is going to get you into shape if you are not there! So the real question is not 'Can I afford this gym?' but 'Can I take out the time to exercise?' Just paying lots of money is no incentive to keep you going. You have to be committed to taking out the time. So many people try to buy health with their cash and fail. The benefits of investing cash are obvious to them, yet they fail to invest time for health. Go to a gym, heck go to an expensive one if you can afford it, but understand that you will have to invest time. That really, is the bottom line.

If you can take out the time, physical fitness is free, literally. Simply because there are so many ways to exercise. Go jogging on the road. Go bicycling. Go swimming. Do aerobics at home in front of your T.V. All these will get you in shape. Yes an equipped gym with a good training program may work better, but only marginally. A gym is just an option not a prerequisite. The prerequisite is time. I spend Rs. 2 and 45 minutes everyday to jog in a beautiful jogging park.

So don't sign up to an expensive gym, end up not going and waste your money. Instead realize that it is time you have to invest, invest it in exercise, get fit and save your money!

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Exercising for back pain

Chronic low back pain is common. However, finding an effective treatment is not. Doctors today are still in search of the elusive lumbar spine pain generator

Not wanting to complicate matters further, the real question I wanted to ask was - Is exercising useful for back pain?
Literature reveals the Cochrane review
A summary of their review says

"Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain, particularly in populations visiting a healthcare provider. In adults with subacute low-back pain there is some evidence that a graded activity program improves absenteeism outcomes, though evidence for other types of exercise is unclear. For patients with acute low-back pain, exercise therapy is as effective as either no treatment or other conservative treatments."

So there is evidence that exercise for low back pain works ! but which exercises ?

Here is a list of a few of them

First the basics

1. Avoid exercising if you have acute back pain, consult your doctor first
2. Don't expect miracles. Exercise is helpful, not curative
3. Always do a few warm up stretches first
4. Start with sets of 5 repititions, 4 times a week and work upto 10 repititions

here goes.....

1. Pelvic Tilt - Lie on your back with knees bent. Put your hands on the abdomen. Then pull your abdomen towards the floor. Use your stomach muscles. Hold for ten seconds. Repeat.

2. Back Lift - Lie on your stomach with your arms overhead. Lift your head and shoulders, without looking up. Hold for ten seconds. Repeat.

3. Abdominal Curl - Lie on your back with your knees bent. Curl up to raise your head and shoulders. Hold for ten seconds. Repeat.

4. Wall slides - Stand with your back against the wall with your knees bent at 90 degrees. The knees should be slightly apart. Hold for ten seconds. Repeat.

5. Leg raises - Lie on your stomach. Raise the leg from the floor. Hold for ten seconds. Repeat. Then lie on your back. Again raise the the leg as much as you can. Hold for ten seconds. Repeat.

6. Knee to chest stretch - Lie on your back with both knees bent. Hold one thigh and bring knee upto chest. Hold for 10 seconds. Repeat.

7. Hamstring Stretch - Lie on your back with knees bent. Hold one thigh behind knee. Now straighten the knee as much as you can. Hold for 10 seconds. Repeat.

8. Heel raises - Stand on both feet. Raise heels. Hold for ten seconds. Repeat.

9. Hip flexor stretch - Lie on your back near edge of bed, holding knees to chest. Slowly lower one leg down, keeping knee bent, until a stretch is feltacross top of the hip/thigh. Hold for ten seconds. Repeat.

10. Aerobic exercise - Low impact aerobic exercise is an essential component of any back training program.

These exercises are a good starting point. A swiss ball could also be used.

For the more enthusiastic, I would recommend the core spinal fitness systems from MedX

40 benefits of aerobic exercise

Everybody knows that aerobic exercise is beneficial. Lots of sites list the benefits. I wanted to make a comprehensive list. I've tried to include as many as I could find. I've tried to avoid repititions.

So here goes

1. Exercise increases the concentration of High density cholesterol (HDL) or good cholesterol

2. It decreases the concentration of Low density cholesterol (LDL) or bad cholesterol

3. It lowers high blood pressure

4. It prevents the development of high blood pressure if you are at a risk

5. It prevents osteoporosis

6. It strengthens muscles

7. It helps you loose weight and prevents obesity

8. It helps lower blood sugar and insulin requirement if you are diabetic

9. It reduces depression

10. It helps deal with pain and stress

11. It helps reduce the risk of cancers of the colon, uterus, prostate & breast

12. It reduces insomnia

13. It reduces the risk of heart disease

14. It reduces the risk of premature death

15. It enhances work and sport performance.

16. It keeps joints, tendons and ligaments flexible

17. It reduces some of the effects of ageing

18. It reduces the risk of developing type 2 diabetes.

19. It decreases the symptoms of arthritis

20. It decreases the number of sick days

21. It increases concentration levels

22. It increases your self esteem and confidence

23. It improves the functioning of the immune system

24. It improves skin tone

25. It decreases the risk of stroke

26. It decreases the incidence of falls in the elderly.

27. It increases your aerobic capacity

28. It decreases a woman's risk of developing endometriosis.

29. It decreases back pain ans improve back stiffness

30. It protects against some brain disorders like Parkinson's, Alzheimer's, dementia

31. It decreases craving in those trying to quit smoking

32. It helps to manage anger

33. It improves digestion

34. It improves body shape

35. It decreases menstrual cramps

36. It improves sexual performance

37. It provides socialisation opportunities

38. It improves cognitive function

39. It provides physical and psychological benefits in pregnancy

40. It decreases the risk of peripheral vascular disease