Using Exercise to Prevent Injury

This article was first published in The Hindu in May 2017.

Have you ever bent down to pick up something and had this terrible spasm in the back, knowing immediately that you’re in for several days of ‘rest and physiotherapy’? We often perform daily activities incorrectly, either because we have no idea just how to do them right, or because we are unable to do them right due to weakness or an imbalance.

Muscles exist as pairs in our body, one on either side. For instance, a pair of quadriceps in the front of the thighs that extends the knee joint. They also have opposing or antagonistic muscles that perform the opposing action. So for example, the quads, as fitness people like to call them, have the hamstrings, at the back of the thigh, that flex the knee joint. These muscles must act in synchrony for us to be able to walk, run, squat, climb and sit. If there is an imbalance between these muscles (as there often is), the result is awkward and difficult execution of movements and a resulting injury or pain.

For a pain-free, active life, we must strengthen muscles throughout the body. Without this, muscles often deteriorate and atrophy (become less) with disuse. Here are three common moves we all perform in our day-to-day life, and how to optimise them, for easy, graceful mobility.

Bending to pick up something heavy

The right way: Get close to the object (or the child), squat (bend knees), bring the weight close to the body and stand up, holding the weight as close to the body as possible. 

Develop the muscles: Do the bent-knee dead lift. Stand behind the barbell (or a heavy balanced pole—for non-gym people), feet hip-width apart. Hinge at the hip by pushing the hips back as you bend forward. As you lower further, start to bend at the knees until you are able to reach and grasp the barbell in the centre. Inhale as you lower. At the lowest point of your forward bend, you should feel the stretch in your hamstrings. Depending on the flexibility of the hamstrings, some people may be able to lower the upper body quite far without having to bend the knees, while others may need to bend the knees at an earlier point. As you exhale, pick up the weight; straighten the torso by fully extending the hip and knee joint. The barbell remains close to the thighs. In the final position, stand up straight, shoulders back and engaged, while carrying the barbell. Lower again by keeping the barbell as close to the body as possible. Don’t allow the weight to touch the ground. Lift again and repeat for 8-12 times. Rest for 30 seconds and do another 3-5 sets.

Reaching up to bring something down from a shelf

The right way: Stand directly beneath and slightly away from the shelf above. Reach up, grasp the object, so the weight is evenly balanced in your hands. Lower without arching the back or leaning backwards. 

Develop the muscles: To develop core, shoulder and arm strength, the plank and shoulder press work well. For the plank, support yourself, face-down on your forearms and toes on a yoga mat. Keep the back flat, abdominals engaged, neck aligned with the spine, so you are not looking too far up or down. Breathe normally. Hold this position by keeping the core engaged for as long as possible. Work up from a 30-second hold to about 90 seconds. The core includes muscles of the abdomen, back, pelvic floor, deep hip and shoulder muscles.

You can do the shoulder press sitting, with your back straight or standing with feet hip-width apart. Hold a pair of dumb-bells in both hands, with palms facing forward, upper arms at the level of the shoulders, and elbows bent at right angles. Lift the weights by straightening the elbows, and push them straight overhead, so arms are parallel, almost touching the ears on the sides. Reverse the movement by bending the elbows and bringing the dumb-bells back to shoulder level. The movement needs to be performed slowly. Perform 3 sets of 10-12 repetitions at each routine. Use a weight that is heavy enough for you to complete just 10-12 repetitions.

Pushing a heavy piece of furniture

The right way: Place yourself directly behind the weight, in a staggered stance (one foot in front of the other), engage the core (tighten stomach muscles), bend forward slightly at the hip joint, place both palms on the side of the furniture, and push with the back flat, engaging mainly the chest and shoulder muscles. 

Develop the muscles: Practise the push-up and plank, to strengthen chest muscles, the shoulders and the back of the arms or triceps. For the push-up, go down on your hands and knees. The palms are placed flat on the mat beneath your shoulders, but wider. The knees are placed directly under your hips on the mat (beginner), or slightly behind the hips (intermediate) or you could go up on your toes (advanced).

Breathe in and lower the upper body towards the mat, by bending the elbows. Lower the chest till it almost touches the floor between your two palms. Exhale as you lift to starting position. Repeat 10-20 times.If you feel you can’t get down on the floor just yet, start with the chest press exercise, which uses dumb-bells to build up strength in the very same muscles, then progress to push-ups.

More Fitness Myths Debunked

This article was first published in The Hindu in March 2018.

When and what to eat; when to work out; which work out for a particular age… there are so many myths in the fitness world. This article tells you what’s right and what’s not.

Vegetarians cannot build muscle or perform as well as athletes who eat meat.

This is not necessarily true. In a beautiful review of research done on Vegetarianism and fitness/athletic prowess, David C. Neiman, examines the impact of a vegetarian diet on fitness in the American Journal of Clinical Nutrition.

Carbohydrate and not protein is the first choice as an immediate source of energy during exercise, even weight training. When the body is depleted of glycogen, it begins to break down protein from the muscle to avail energy.

Protein is necessary for repair and growth of muscle during recovery.

It has been found that a vegetarian diet does not necessarily lead to protein deficiency as believed. One does not need to eat protein exclusively from animal sources to reap the benefits. What is required is a variety of vegetarian foods, including different kinds of pulses, lentils, nuts, seeds, whole grains and cereals. Although an isolated plant food source does not contain all the essential amino acids that are required and cannot be considered a “complete protein”, eating combinations of varied plant foods will create the necessary complete proteins.

A vegetarian diet also encourages the intake of a larger quantity of fruits and vegetables, which contain antioxidants that reduce the oxidative stress of exercise.

Protein requirements for recreational weight training to build muscle can be very easily met with a well-balanced vegetarian diet. Protein supplements are certainly not mandatory. Consuming adequate amounts of pulses, whole grains, nuts and seeds will fulfil the recommended amount of 0.8-1.4 gm/kg body weight of protein/day depending on your level of activity.

Your training intensity and strategy determines how much muscle you build with weight training. Consuming protein powders in the hope of building muscle, while not training adequately does not.

Famous cyclist Adam Myerson, body builders like Alexander Dargatz and Andreas Cahling, legendary tennis players Chris Evert and Martina Navratilova, celebrated track and field athlete Edward Moses, Greg Chappell and the late Jack Lalanne, body builder and fitness expert, are all vegetarians or vegans and have magnificent bodies to show for it.

Vegetarianism should not be a reason for an ineffective workout or a well-trained body. The fundamental principle is balanced nutrition; smart training to keep fat per cent at the optimum and strength, stamina and flexibility to the maximum.

The best time to workout is in the morning:

Hard to convince someone who is not particularly a ‘morning person’ of this theory. It is not necessarily true. Every individual has a different body rhythm. Not everyone can jump out of bed and run out the door in their trainers at an unearthly hour. Particularly when starting a fitness programme, try and accommodate it into the most comfortable time of the day for yourself instead of adding further stress by trying to wake up early.

Some people do very well with a mid-day workout while others prefer a late evening routine. A short intense pre-lunch workout may be just right for a working person. By the end of the day she may be too tired to fit in an hour in the gym. Alternately, others may find that working out later in the evening is de-stressing after a long day and helps them unwind and even sleep better (provided it is not too close to bed-time).

Work with your own body, not against it. More important that when you workout, is how you workout and how you feel after your workout and for the rest of the day. If you are going to walk around in a daze all day as a result of an early morning, this may not be the best option for you.

Age is a constraint to working out:

Very often I hear people say they are too old to start working out.

What is “too old”? Today, 40 is the new 30 and 60 is the new 40. Age should never be a constraint to starting an exercise programme, provided you have clearance from your physician and are monitored and guided by qualified professionals.

I was recently most delighted to receive a mail from a reader who says she is in her 50s and participating in half marathons. We don’t often see this in our country. Women, particularly, tend to get complacent after their child-bearing years and settle into a sedentary lifestyle, with perhaps a walk in the park and some gentle yoga to convince themselves that they are working out.

Starting a Weight Training programme as late as the 90s has been found to be beneficial in improving strength, muscles mass and daily functionality.

The motive for exercise changes with age. As children, it is mostly fun. In the 20s, it is typically cosmetic. Prevention of disease is far from even contemplated. One feels invincible, the only concern being, getting into those skinny jeans. And of course these days it is hip to be seen gymming or carrying around yoga mat.

In your 30s, you probably start to think about needing to lose all that weight you gained during pregnancy. If you have been unfortunate enough not to have exercised previously, then the annoying back pains, fatigue, gastritis, depression, mood swings and so on set in and life becomes a chore. Maybe exercise will help, you consider it.

In your 40s and 50s, women particularly, come into their own. They are more confident and able to make decisions for themselves. Societal and family pressure is not a priority. The reality sinks in, as the weight gets more obstinate and unyielding. Lifestyle diseases like hypertension and diabetes may make their appearance. Or at least you consider the possibility that they may. So you begin your journey into fitness. If you are already a veteran, you will be enjoying the benefits.

Later in your life, basic day-to-day functionality is of prime concern. Most people exercise later in life only because they have probably been recommended exercise by their physicians to control blood pressure, diabetes and so on. The incidence of falls and injury due to lack of balance increases and the fear of invalidity and dependence can keep people active.

Point is: one doesn’t even need to justify the reasons to start exercising at any age. It should be a non-negotiable part of your day, just like cleaning your teeth or eating. If you haven’t started already, please do.  

Is Your Trainer Fit for You?

This article was first published in The Rotary News in Aug 2018.

When you start on your fitness journey, or even if you are already immersed in it, you may want to hire a personal trainer to coach and guide you. Many people need that extra motivation they hope their trainer will provide. So how do you go about engaging the right trainer and how do you decide if he is the right fit for you?

There are several bodies that certify trainers. It could be the IFAA-India (International Fitness and Aerobic Academy); ACE (American College of Exercise); ACSM (American College of Sports Medicine); or the National Academy of Sports Medicine and several more. Your trainer may be a physiotherapist by qualification who is specialised in a particular field such as strength training or pilates. Many trainers who are perhaps athletes or sports persons, or have been body builders, are absorbed by a fitness facility and trained there to work with their clients. Check into their background when you start to work with a trainer.

Although your trainer’s skill and knowledge are important, what is even more important is his or her interpersonal skill, emotional and social intelligence and ability to guide and motivate. He or she may be very qualified and knowledgeable but lack in empathy and understanding of the clients’ needs.

What is your trainer’s fitness philosophy?

It is worthwhile to ask your trainer what his idea of fitness is. Is it just about looking buff or lean, or is it more holistic, combining nutrition, motivation and overall wellbeing? Does he understand his clients’ needs or works solely from his own perspective? Does he believe in helping others achieve their goals?

Here are some questions to address

• Does he understand the various aspects of fitness such as aerobics, strength, flexibility etc, and how  these should be applied to you?
• Does he understand the importance of diet and can he advice the right diet for you or refer you to a nutritionist? Does he talk to you about your dietary habits?
• Does he know enough to handle your health condition? Say, you are diabetic and on medication, does he know enough to manage you while exercising? Does he ask about the medication you are taking? Or, if you are a senior person, can he handle an older client? Has he worked with older clients before?
• Does he ask you detailed questions to understand your lifestyle? For example if your job is sedentary, if you travel a lot, if you socialise a lot, where you eat, if you have trained before, what kind of exercise you enjoy the most and so on.
• Does he give you motivating tips to fill in the rest of your day (not just the hour in the gym)?
• How does he motivate and challenge you? Does he use negative associations (by saying — you are fat and need to lose weight) or is he positive in his approach (by saying something like losing weight will help you lead a healthier, more enjoyable life and praising you when you improve)?
• Does he know just how much to push and challenge you or does he absolutely insist on pushing you beyond your capabilities to a point of exhaustion and injury?
• Does he constantly compare you with other clients?
• Are you motivated and inspired by him?
• Does he use encouraging language and praise you often when you achieve small goals or does he make you feel you are just not good enough?
• Does he help you set realistic goals and achieve them?
• Does he teach you your exercises, explaining them to you, helping you understand why you do them and what body part they address etc?

Every individual is different and needs to be treated as such. The goals you set for yourself should be your goals and not your trainer’s. Your trainer should be a person who can guide you towards your specific goals. He should also educate you about your fitness routine. The objective should be to exercise independently when necessary and not be dependent on a trainer telling you exactly what to do and how to do it for the rest of your life. It’s okay to want to be motivated or inspired, but at some point the motivation should come from within you.

Finally, a trainer who wants you to be dependent on him is not really working with your best interests in mind. If you have a great trainer, you should eventually be able to exercise on your own, know enough about it and understand why you are doing what you are doing. You should be confident enough to be able to handle your own fitness routine and perhaps even inspire others. 

Psychological or Emotional Well-being

This is an excerpt from my third book FIT AFTER 40 which is out in stores and on Amazon now.

How does one ever know if one is truly psychologically well? I’m not sure there is a definitive answer to that question. How we feel changes and often depends on how we react to our circumstances and the world around us. 

We are subject to a range of emotions. The balance of these emotions is more important in the overall scheme of things. Anxiety, fear, sadness and other negative emotions are not necessarily bad for us. They are, instead, signals for us to look at a situation and understand what to do about it. Instead of suppressing these emotions (which sometimes may result in many unwarranted repercussions like depression, post-traumatic stress disorder, loss of friendships, isolation and so on), use them as a reminder to look deeper. 

There may be times when we feel terribly unwell within ourselves. Times of stress, family or work pressure or the loss of someone dear can upset our emotional/ psychological equilibrium quite dramatically. There are other times when we are calm even under stressful situations.

Some of us are aware of these changes as we experience them and explore them to understand the motivations and delve into possible changes to implement. Some are quite naïve about inner well-being and its implications on health. 

Think about it. Wouldn’t you say that the range and complexity of your psychological inner life is just as much a reality as your physiological and physical body? 

The Greek philosopher Socrates had said, ‘An unexamined life is not worth living.’From time to time ask yourself what’s going on in your mind. What do you think about life in general; your own life in particular? What meaning or purpose do you find? Are you happy, fulfilled, discontented or disinterested? What are the values that drive your attitudes to your existence? What brings you joy? What are your loves, your hates and your disappointments? Have you any idea as to who and what you are as an individual or how you are becoming your own person? 

Self-awareness is key to growth. How can we move forward if we don’t know where we are? 

Our emotional well-being is quite different from our physical well-being although they are intimately intertwined. While we can certainly improve mood and sense of well-being by incorporating regular exercise into our day, being ‘well’ emotionally requires other practices like deep contemplation, meditation, reflection and an understanding of our true motives and ourselves. It requires us to ask ourselves the question, ‘What will truly make for a better life for me?

Mind Your Body

This article was first published in The Hindu on August 06, 2018.

How I discovered the joys of exercise and self-awareness.

Way back in 1994, when I came back to Ooty from Chennai, after my post-graduation to join my mother’s obstetric practice, I didn’t quite realise what I had bargained for. In those days, Ooty was a small town with almost nothing going on. My life revolved around work. The isolation, frenzied work schedule, with a complete lack of friends, stimulus, entertainment or creative outlet, was nearly unbearable. I needed a coping strategy. For me, that came in the form of exercise.

I had always loved fitness even as a child, but now I was using it almost as a refuge. My long morning walks, aerobics in front of the TV (those days there was an Australian show on), and yoga, were not just about staying fit or losing weight. The endorphins kept my moods from plummeting.

From there was born my renewed respect for what exercise could do for me, not just physically but emotionally. Looking back, I may have been using exercise almost like a drug, to survive. Did I go into over-training? Perhaps at times I did, those initial few years. Today, I am wiser for it. I am very mindful of just how I use it, very aware that everything, however good, can be detrimental, if over-indulged.

Soon I started to recognise that my patients could also benefit from exercise. Many of their problems resulted from a lack of fitness or strength, being overweight or too frail. This was the beginning of my foray into fitness, as an extension of my medical practice.

How do I teach women to include fitness in their lives? How do I help them enjoy exercise? I certified to be a Fitness & Lifestyle Consultant from the National Association for Fitness Certification (NAFC) in the US in 2000, and started teaching exercise to women in Ooty.

My first and second books, Get Size Wise and Gain to Lose, were products of my experiences, and talk of the basics of exercise with plenty of real-life stories that I had encountered with women every day in the context of them trying to lose weight or get fit.

By the time I was ready to write my third book, Fit After 40, I had taken an extended course in positive psychology. I am very mindful of the fact that ‘fitness’ and ‘wellness’ never deal with only the physical self. The mind and body are so intricately connected that one can never truly be ‘fit’ without addressing our inner well-being.

Positive psychology is a fascinating field. I’ve always been interested in the workings of the human mind. In fact, my first choice for post-graduation was Psychiatry. Eventually, however, I changed my mind and chose ObGyn as it was a much ‘cheerier’ field with new beginnings and mostly happy endings. Psychiatry seemed rather gloomy and depressing.

Positive psychology deals with flourishing. How does someone who is doing okay, do even better? How do you thrive instead of just survive? This interested me greatly. Why do some people flourish while others languish? Positive psychology gave me an insight into all the above questions and a way to approach growing older, in my book. It also helped me personally, more than I can express. I realised, it all starts with self-awareness.

Self-awareness is not only knowing your preferences, weaknesses, strengths or even understanding your inner world, though of course, that’s a large part of it. It also deals with recognising just how we monitor and negotiate our inner world, and what we notice or understand regarding ourselves. So for instance, do we often admonish ourselves with ‘I should/shouldn’t have done that’? What is that self-talk that goes on 24/7 inside our heads? What are our preconceptions, biases and conditioning, and where do they come from? Identifying all this in a non-judgemental manner is the path to self-awareness. The key word is non-judgemental.

My own self-narrative had a lot of editing to be done! I learned that I was far too self-critical. While it may have helped drive me to work harder or be better, it couldn’t have been too good for me. We are taught to be compassionate towards our patients; self-compassion, however, is not always easy. I had to learn to take a step back to a better vantage point and just observe instead of jumping in with my own disapproval and/or guilt. I had to ask myself some very hard questions, and sometimes I didn’t like the answers! I’ve learnt that it’s okay to be vulnerable sometimes, to refuse sometimes, or to agree to disagree (without feeling guilty about it!). Being self-aware relieves you of the burden of trying to explain yourself, to fit in, or for that matter, to stand out!

The most important and longest relationship we will ever have is with ourselves. Writing the book helped me explore some fascinating aspects of my own self. It’s a journey well worth spending time on and being truly mindful of.

Fit after Forty is out on Amazon! Do take a look and order your copy now!

More Than Just Weight Loss

This article was first published in The Hindu on 15th June 2013.

Instead of starving yourself to lose weight, nourish your body and mind with an understanding of nutritious food and exercise.

Most people want the easy way out when it comes to losing weight; perhaps with a couple of sessions in an expensive spa that promises miraculous results. If it were that easy, we would not be at the edge of an obesity epidemic. There would be innumerable slim bodies walking around.

It is this ability to convince ourselves when we desperately want something to be true that drives people to believe empty promises. We tell ourselves that skipping carbs for a month is the solution to our widening waistline; that we can manage to survive without regular exercise; that we can somehow escape the repercussions of an unhealthy lifestyle. We suffer from what is called the ‘confirmation bias’. We will find every single piece of information possible to confirm what we believe (and want) to be true. So going for a walk for 45 minutes a day is not as appealing as say drinking apple cider vinegar, having a body wrap, wallowing in a mud bath or following the latest diet.

We are thrilled to read research that finds exercise does not really help with weight loss. What we forget to do is to read between the lines. It is true that exercise alone is not sufficient for weight loss because the number of calories burnt during one session is minimal compared to what is required to lose weight on a scale. It is also true that cutting down on calories creates a faster calorie deficit leading to quicker weight loss.

However, in the long-term, it is the combination of regular exercise and a well-balanced diet which will help you continue to lose weight, however slowly. One cannot go too low on calorie intake. This defeats the whole purpose of trying to get fit. With an abnormally low-calorie intake, one cannot function normally or be productive. It also sets the stage for muscle loss as the body tries to cope. It makes you ill-tempered, hungry, depressed and just plain unhealthy.

Ask yourself how long you can persist with such a diet. When you do go back to eating normally, you will find that the weight comes right back (with interest) and all those agonizing days of dieting are futile. Your body has acclimatised to a lower calorie intake by lowering its Basal Metabolic Rate (BMR). This highly resilient machine can alter its inner functioning to accommodate your behavior (however bizarre), to a large extent.

Serial dieters, who swear that they lose weight with one diet after another, fail to realize that they put back all the weight after every cycle. Their energy could have been effectively redirected instead to understanding food and learning to eat healthy, along with including exercise into their routine. This would have produced longer-lasting results If persisted with and, yes, it can be persisted with provided the intake of food and nourishment is adequate.

Including regular exercise into your day has several benefits besides burning calories. First, it improves your mood. Increased levels of endorphins in the brain create a sense of well-being. This is in direct contrast to how one feels when one is on a starvation diet; frustrated, anxious, irritable and low on energy.

Second, besides burning calories, regular exercise — especially weight training — helps manage blood sugar, bone density, muscle mass and improves muscle structure and strength. It elevates the BMR and helps burn more calories even while at rest. Regular cardiovascular exercises have been proven to have other benefits like lowering cholesterol, managing high blood pressure, preventing and treating depression, menopausal symptoms and premenstrual syndrome, even managing migraine and anxiety.

Third, and most important, exercising regularly brings about body intelligence and awareness, which helps you eat better. You become more conscious about how you nourish your body. You are more discerning with your food choices. You develop a greater respect for your body.

All the above spin-offs become apparent when one persists with an exercise routine. A couple of random sessions are not enough to give you a realistic idea of the benefits of exercise. I know people who work out for a week or a month and then decide it’s not worth it because they don’t see “results.” The results they seek — drastic weight loss, for instance — may not be realistic to begin with. They veer off course to more intriguing options like ‘weight loss parlours’ and ‘health farms’ in the hope of achieving their goals more quickly. This endless loop — trying to lose weight, losing some and putting it back again — goes on, exhausting the body, not to mention the spirit.

Set several goals other that ‘weigh on the scale’. Weight on the scale is not necessarily an indicator of health. Stamina, strength, flexibility, endurance, balance, coordination, reflexes are all integral parts of fitness and can only be improved if worked on using a well-designed fitness routine.

My advice is to stop focusing on weight loss alone and focus instead on improving overall fitness. Over a period of time, the weight will come off. You will get fitter, stronger and tangibly healthier. Your body will function better and you will enjoy a better quality of life.

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