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.

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. 

Working Out is Fun

This article was first published in The Hindu in June 2012.

Can’t enjoy exercise? Learn how to like it.

It comes from the joy you feel in the freedom of movement. The understanding of your own body. From watching your body grow from strength to strength, the changing posture, shape and tone. The improved stamina and flexibility. The incredible power you acquire over your body. The energy. The calming of the mind.

Sounds too good to be true? How can anyone actually enjoy exercise? Well, I admit not everyone can. But you can try and get there.

Find the right programme

It is important to find the right programme. Don’t imagine that you will fall in love with the weight room or the TRX like your best friend did. You may not be able to get up and run out of the door first thing in the morning. You have your own personality and preferences. It’s possible that you may like cross training and boot camp. Or you may prefer to include a few days of yoga with your strength routines.

Speak to a fitness professional to first identify and understand your unique needs. More importantly understand your strengths and weaknesses.

If you have really poor coordination and are tone deaf, you could still go to a zumba class for the fun of it but chances are — by the time you get your head around those steps, the choreography and the music — you may not be able to sustain the required level of intensity to benefit your cardiovascular endurance. Or worse still, you could injure yourself trying to keep up. Perhaps you should run to maintain the intensity of your cardio and improve your stamina.

On the other hand if you love to dance and move to music, a walk on the treadmill will probably bore you to death. You should then use an aerobic class with lots of music and dance moves as your mainstay of fitness and use the treadmill once or twice a week to get a quick workout when time permits nothing else.

I know women who have invested in expensive exercise equipment thanks to a savvy sales person or because a friend has one. You don’t have to buy a cross trainer just because you can afford to or because everyone else is doing it. However attractive it may sound to have the option of being able to “exercise any time you want”, just buying a machine will not make you do so. Exercising on your own at home requires an immense amount of self-motivation. Some people need the encouragement of a trainer or group exercise. Others can do it alone.

Women, particularly, thrive in group classes. It seems to appeal to their social nature. You have to determine what kind of group class will appeal to your senses and which one is good for you. Someone with an unstable knee joint, for instance, should stay away from a step class and high impact activities unless they strengthen their knees with strength training and isolation exercises for their leg muscles.

The lucky ones

Very few can do just about anything, love it and, more importantly, be good at it! Take them to a dance aerobic class and they are in their element, able to master the choreography and move flawlessly to the music. Ask them to a cross-country run and they are quite comfortable running through the undergrowth. In the gym, they love to train with serious body builders! These are the annoyingly lucky ones. They can adapt and avoid boredom just by the sheer variety of activities available.

However even such people need to be aware. It’s one thing to enjoy something but is that what your body needs? Are you benefiting from that particular form of exercise? Since time is precious, you need to use it wisely for the activity that benefits you the most.

Mostly, you have to find your niche and develop a discipline to participate in the form of exercise that you require for your specific body type. Do it often enough and you will get better at it. This makes you more confident and proud of yourself. After a while it becomes a habit. An enjoyable one at that!

Yes you can learn to enjoy your fitness routine. It can become a part of your daily life. There is something out there for you. All you have to do is find it! Feel younger, stronger, more cheerful, energetic, optimistic and driven by including the right exercise routine into your day.

Quick tips

Go through a fitness assessment to determine your body requirements.

Include strength, flexiblity and cardio into your routine. Doing just cardio day after day is not only boring but also detrimental.

Add strength training and flexibility to correct muscle imbalances. A runner, for instance, suffers from tight hamstrings and hip flexors. Unless she goes through a routine specifically designed to stretch these muscles, her run will suffer and eventually culminate in injury.

Setting goals and working towards them is another way of staying with a programme. Achieving success is motivation enough to go further.

Don’t wait for injury or a pronouncement of disease to start exercising. You can prevent injury and degenerative disease with exercise.

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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How Old Are You Really?

This article was first published in Rotary News in April 2018.

There are two aspects to ageing. Your chronological age is the calculated number of years you have lived. Your biological or “real” age  refers to the current condition of your physiological body at its very basic cellular level. These two are not necessarily one and the same. An individual may be chronologically 30,  but might have the body and mind of a 55-year-old. He could be overweight, lethargic, with poorly conditioned muscles, poor memory, productivity and low stamina. He may be stressed, depressed, with a laundry list of medical conditions and pills to manage them.

On the contrary, someone could be 50 years old chronologically but have an actual age of a 35-year-old in terms of energy, stamina, strength, and pure joi de vivre. 

Factors that ascertain your Real or Biological age

These are blood pressure, heart rate and other metabolic parameters such as  blood sugar and cholesterol, eyesight, lungs, heart, vocal cords, skin turgor, energy levels, physical appearance, condition and tone of your muscles, mental acuity, memory, level of independence, fat percentage, lean body mass and fitness levels (cardio vascular endurance, flexibility, strength, agility, reflexes, balance, coordination and so on).

Your ‘real’ or biological age

Of course genes set the stage for a good or poor quality body. But lifestyle choices are the ultimate predictors of the ageing process. However good your genes, if you subject your body to stressors such as tobacco, alcohol, drugs, poor lifestyle choices on a daily basis like unhealthy food and lack of proper exercise, rapid ageing is imperative. It is said that your genes load the gun but your lifestyle pulls the trigger.

Here are some lifestyle measures that can arrest and even reverse the ageing process:

• Eat right – Eat food rich in anti-oxidants, minerals, vitamins and fibre. Fruits, vegetables, berries, nuts, seeds and pulses provide protein and good quality fats. Avoid processed and refined food, tobacco and excessive alcohol.
• Exercise the right way – A well designed fitness routine should include cardio vascular activity such as running, speed walking, cycling or aerobic sessions. It should be balanced with a strength training routine to build muscle and a stretch routine to maintain flexibility of the muscles. Muscles being critical for movement need to be worked against resistance (either an external weight or one’s own body weight) to be maintained at an optimum or improved. They also need to be stretched to maintain elasticity.

Muscle atrophy (decrease) and frailty with age and disuse is the primary cause for lack of mobility. It affects performing even the most rudimentary tasks. Modalities like yoga and total body stretches keep the body limber, prevent pain and addresses poor posture due to muscle imbalance.

Exercise is most definitely the closest we have ever come to an anti-ageing pill. Expensive skin creams that promise wrinkle-free skin, cosmetic surgery, laser ablation, Botox etc. are only solutions to the superficial signs of ageing. They cannot come close to the benefits obtained from a regular heart pumping, well-planned exercise routine.

• Maintain your body weight – Weight gain with age is not inevitable. With the right nutrition and exercise, it is possible to maintain your body weight and in fact even improve the quality of your body.
• Manage stress – Stress is very much a part our everyday lives. Eliminating it altogether is of course too much to expect. Managing stress effectively however is possible with meditation, relaxing techniques, time management and training the mind to handle situations and stress differently.
• Nurture a hobby/passion – Simple things like developing a hobby or even working on something you love and are passionate about can change one’s perspective to ageing.
• Maintain strong relationships – Strong ties with family or close friends can be enormously rewarding experiences that add meaning to life.
• Sleep well – Sleep is not only restive but also restorative. Long-term sleep deprivation has been known to be associated with an increase in Type 2 diabetes, obesity, hypertension, depression and even memory and attention problems. Work related sleep dysfunction (such as in shift workers, doctors and nurses), poor sleep hygiene, stress, obesity, overeating near bedtime, can all lead to poor sleep. Good quality sleep is closely related to a good quality, productive life.

To evaluate your Real age, ask the following questions 

• Do you enjoy life? Do you look forward to the new day?
• Do you have strong, nurturing relationships?
• Do you enjoy the work you do?
• Do you exercise regularly, sleep well and eat healthy?
• Are you excited to get out of bed in the morning? (Granted that sometimes some of us are too fatigued to register excitement and just wish for a few more moments of blissful sleep, but that is a different discussion altogether!)
• Do you feel you have purpose and meaning in life or are you drifting along wondering what to do?
• Are you passionate about some cause or hobby?

Evaluate your fitness 

• Can you run or even walk up a flight of stairs and not feel like you are dying at the end (or middle) of it?
• Can you touch the floor standing up without bending your knees?
• How fast can you walk a mile and how quickly do you recover from the exertion? (Called the One Mile Walk test, this can be evaluated in a gym setting).
• What is your weight, fat percentage and your waist circumference?
• How many proper pushups and squats can you do?
• How much medication, besides basic supplements, sit on your table waiting to be consumed every day?

Ageing is the most natural process of the human body and certainly cannot be arrested altogether. It can however be done gracefully with every attempt made to remain independent and productive, even if only to oneself.  

Connecting the Dots……

This is why I teach Fitness & Wellness

On returning from my post-graduation to work at my family-run hospital in Ooty, in
1994, I believed, if there was a condition where one may slowly and silently perish from isolation and a suppression of creative energy… this was it! I lived within the four walls of my home and hospital, working endlessly. That was all I did.

Of course, I felt plenty of self-pity for my ‘hard-working’ self. Felt very self-righteous actually! I thought, ‘Life is unfair. I am meant do bigger things!’.

From this came an opportunity to create something powerful and rewarding in ‘small town Ooty’ over and beyond my Obstetric practice. I nurtured my passion for fitness and
certified as a Fitness & Lifestyle Consultant to support my medical career, propagating fitness to women as a form of ‘Preventive Medicine’. I started ‘TFL’ (Training for Life’) in
Ooty in 2000 and in Chennai in 2007. It became an extension of my medical practice. One that I believe to be very relevant to women’s health and wellness and also enriched patients, clients and women across the board, from all walks of life.

Today, I am appreciative that I am able to translate my passion for fitness to touch and change women’s lives. Am ecstatic to see my alternate career lead to a metamorphosis in
several women who have benefitted from TFL, leading to an incredible improvement in their ‘Quality Of Life’. 

‘Connecting the dots’, I believe this is what I was meant to do……….change lives.