Choices Women Make.

(This article appeared in the Rotary News Dec 2014 as “Women There Is No magic Pill”)

After my first book, ‘Get Size Wise’, I have been doing a kind of book tour – readings and book discussions in various cities. I have spoken to hundreds of women about fitness and exercise. I am often surprised at the some of the questions I get. Mostly, pleasantly surprised. I see a thirst for honest answers and solutions to real life problems that some women seek. I see a real need for a deeper understanding of the term ‘lifestyle change’.

Many of them have been through diverse experiences with drastic weight loss, trainers, gyms, health drinks and expensive supplements to lose weight, extreme diets and so on. Most are still searching for that magic pill.

I also find that the women most open to influence and guidance are the over-forty-year-olds. By this time they have experimented with all that there is to in weight loss and finally found it notwithstanding. They have discovered that being in a raging hurry to lose weight or gain fitness is what has them in their current situation in the first place, often still overweight and unhealthy, so instead of losing more time on trial and error, they want to get serious about training.

There are many however, who are still trying to play the blame game. I have had several occasions where short of tearing my hair out in frustration, I fenced accusing questions and counter arguments about why a certain woman has not lost weight, or why she finds it so utterly difficult to do so.

Some conversations went like this –

She – I just find it impossible to lose weight doctor. I have done everything including diet, yoga and walking. I even went to an ashram and stayed for fifteen days. I lost weight but gained it all back.

Me – This is exactly what I have been trying to explain – rapid weight loss, especially with drastic diets are not sustainable. You will regain the weight.

She – So I think I am doomed to be fat.

Me – No you have not done the right thing. The right combination of exercise and diet will work, even if only slowly.

She – But I have tried everything doctor!

Me – Have you started weight training to build muscle in addition to Yoga and walking, and eating the right quantities of food to nourish your body?

She – I think all that is not possible. I don’t have time.

Me – You don’t have to spend more time on exercise, just divide the time sensibly and change your eating.

She – I don’t think that is possible doctor. I know I can’t lose weight. I have tried everything.

So, she has made her choice. A choice not to make the time. A choice not to understand the bigger picture. A choice not to lose weight sensibly.

I think the fitness industry, innumerable food options and the media are largely to blame for the current crisis in women’s inability to lose fat and keep it off successfully. Their consistent search for the unattainable.

Of course the women are to blame as well because they often believe what they like to hear. Such promises as ‘lose five kilos in a week’ (or less) are much appreciated and sought out. The industry propagates these myths for monetary gains. The media taps into our insecurities. The constant message of, ‘you are not good enough, we can make you better, buy our lipstick, silicone breasts, body shaper or what-have-you’ is sufficient to convince any young (or old) woman trying to ‘fit in’ or ‘look better’.

It is a choice we make and all choices have consequences.

 It may appear that you don’t have a choice. That you don’t have the time to actually fit in an exercise routine (one hour a day) because you are too busy working, keeping home, travelling etc. It you take an honest look at the way you spend the hours in your day however, you may find to your surprise that there are many hours in the day that are really ‘time wasters’. Hours you spend watching mindless TV or surfing the net. These hours can be put to better use such as be invested in regular exercise.

You DO have a choice

– You could continue to convince yourself that you don’t have time, or you could make the time.

– You could wait for diabetes, hypertension and heart disease to afflict you, or you could start preventing their onset now.

– You could wait for obesity to set in, knees to hurt, depression to envelop you, or you could start changing your lifestyle now.

Every choice has a consequence. If you begin making the right choices, you will eventually face the incredible consequences of a better quality life.

Dr Sheela Nambiar MD, Obgyn

Fitness & Lifestyle Consultant NAFC

Author – Get Size Wise.

Email – Sheela.nambiar@gmail.com

Exercise Guidelines For Indians

Almost 30-60% of Indians in urban India have been found to be overweight or obese or have abdominal obesity. It has also been found that Indians are at a higher risk of developing obesity related problems like Diabetes, Hypertension and Heart disease at lower cut off values for BMI (Body Mass Index) and Waist Circumference. Indians suffer inherently from a lower muscle mass or sarcopenia. This leads to several of the health problems like central or abdominal obesity that the Indian is more prone to. Our fat percentage and waist circumference is higher for a comparative body weight to our caucasian counterparts.This is one of the major causes for the higher incidence of diabetes and Coronary Heart Disease in the Indian subcontinent.

According to the Consensus statement for physical activity for Asian Indians (Misra et al JAPI vol 57 Feb 2009) – Cut off values of BMI for the Indian population :

Normal BMI = 18.0-22.9 kg/m

Overweight = 23-24.9 kg/m

Obesity = more than 25 kg/m

Consensus statement for cut off values for Waist circumference:

Women = 31.1 inches (80cm) and above should be considered obese

Men = 35.5 (90 cm) and above to be considered obese requiring intervention.

Definitions of Physical Activity Intensity Levels

1. Low-intensity physical activity elicits a slight increase in breathing rate. (e.g., slow walking less than 3 km/h on level firm ground, house work like cleaning, cooking and dusting).

2. Moderate-intensity physical activity elicits a moderate, noticeable increase in depth and rate of breathing, while still allowing for conversation (e.g., walking 3–6 km/h on level firm ground, water aerobics, moderate intensity aerobics, cycling at a speed of <16 km/h and hiking).

3. Vigorous-intensity physical activity elicits a noticeable increase in depth and rate of breathing. The individual will not be able to speak more than a few words without pausing for a breath (e.g. walking a kilometer in less than 10 minutes, jogging/running, cycling, higher intensity aerobic dancing, and jumping rope).

Exercise guidelines for healthy adults: consensus statement –

If you participate in Moderate Intensity Exercise – Aerobic activity of moderate intensity : brisk walking, stair climbing, cycling, jogging – for 30 minutes 5 days a week

Muscle strengthening exercises : resistance training, own body weight exercises, exercises, exercises using dumbells or machines – 1-3 sets of 8-12 repetitions targeting major muscle groups. This is to be done 2-3 times a week.

If you participate in High Intensity Exercise – Aerobic activity of higher intensity like running, high intensity aerobics, football etc for 20 minutes 3 days a week is sufficient

Muscle strengthening exercises – more than 3 sets targeting major muscle groups 2-3 days a week.

Exercise guidelines for Children and youth aged 5–17 years consensus statement –

Children who are sedentary and obese should start with at least 30 minutes of moderate intensity aerobic activity everyday. This volume of exercise should increase gradually to obtain at least 60 minutes of aerobic activity daily. – Those children who are already quite active and not obese require at least 60 minutes of vigourous exercise, which could be in the form of sports everyday. – In addition they will require muscle strengthening exercises for a minimum of 20-30 minutes 2-3 times a week. Exercises like jumping, squats, push-ups, situps, lunges etc using own body weight may be performed.

Television and computer time involving sedentary activity should be restricted to less than 2 hours a week.

Exercise guidelines for pregnant women consensus statement –

All pregnant women should get a clearance from their Obstetrician before starting or continuing to exercise during their pregnancy. – There are certain contraindications to exercise in pregnancy such conditions as threatened pre-term labour or bleeding and this needs to be discussed with the Obstetrician. – Healthy pregnant women, with no other contraindications can continue to exercise as per the recommendations for the Healthy Adult – A minimum of 30-60 minutes of Aerobic activity per day.

– The aerobic activity should be low impact. Avoid high impact activities like running or high impact aerobics or contact sports.

– Resistance training should be performed to strengthen the specific muscles about 2-3 times a week. – One exercise per body part can be chosen – 2-3 sets of 12-15 repetitions of each exercise using light weights may be done.

– Stretching to be done for a few minutes everyday.

– Pelvic floor strengthening exercises may be continued throughout the pregnancy.

As the pregnancy advances the woman may be unable to exercise at the same intensity as during the first two trimesters. She may continue to do a low intensity aerobic workout, stretches and relaxation everyday.

There are some do’s and dont’s while exercising in pregnancy –

– Avoid very high intensity exercise. Avoid exercising in the heat. Drink enough water. Avoid high impact exercise or contact sports. Stop if you feel faint or dizzy. Avoid exercise if there is a history of pre-term labour, hypertension or bleeding. Avoid any exercise that requires you to lie on your back after the first four months of pregnancy. Exercise with perfect form to avoid injury.

After a normal delivery she may start exercising once she feels comfortable which may be in a week to ten days. After a caeserean she can start exercising after six weeks.

Exercise guidelines for the elderly consensus statement –

All adults over the age of 40 need a medical clearance from their physician before commencing an exercise routine for the first time. If one has been exercising throughout their life, they may continue to do so with some decrease in intensity levels if so required. The focus of exercise in the elderly is more on building strength and muscle mass than on weight loss. Increasing muscle mass and strength is beneficial in allowing the older individual to continue to live as normal a life as possible without being dependent on others.

– Recommended doses of aerobic activity and muscle-strengthening exercises for men and women over 65 years of age are similar to those for healthy adult population. That is aerobic activity for about 30-45 minutes a day at a moderate intensity.

– Resistance training to improve strength and muscle mass needs to be incorporated on at least 2-3 days/week which should involve all the major muscle groups, one exercise per body part, 2-3 sets of 8-12 repetitions is recommended. The benefits of resistance training include preservation of muscle mass and prevention of age-related sarcopenia.

– Greater muscle strength and power enable the maintenance of function and prevention of disability, including a lower risk of falling. Balance training, along with activities to strengthen the muscles of the legs, back and core muscles is the best strategy to reduce falls and complications from falls. This also increases the chances of the elderly person staying independent throught his/her life which is essential for morale. – Daily “activities” that involve moving around, climbing stairs, lifting, carrying, pushing, gardening, cleaning etc should be maintained as long as possible because they can also benefit muscle and bone health.

– In sedentary individuals, gradual escalation of physical activity is recommended, after pre-activity medical evaluation especially in those with chronic diseases, particularly CHD. All decisions regarding the initiation of exercise programs for the elderly should be taken in consultation with a physician.

– Sudden commencement of physical activity, especially wihtout medical clearance should be avoided in the elderly.

Exercises for persons with disabilities cannot be generalised. The exercise routine needs to be designed according to the disability encountered.

Dr Sheela Nambiar MD Obgyn, Fitness & Lifestyle Consultant NAFC (USA)

This article was originally written for Sports Authority Of Tamil Nadu. http://www.sdat.tn.gov.in/index.php/fitness/daily-fitness-regime