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

Get Size Wise….. my book is finally published!

 

After a three-year wait my book “Get Size Wise” is finally out It published by Rupa Publishers, India. It took me about a year to write it and two years to get it published. Finally it is done and am hoping it is widely read.

So, this book is basically for the Indian woman (because I work primarily with Indian women), but the basic principles would apply to women anywhere. It gives her an idea of how exactly to go about her fitness routine. What she needs to include, what to be wary of, setbacks to anticipate and so on. No, it does not supply any magic tricks to “lose weight”, “get slim” and more such crap.

This book is more about Fitness than Weight alone.

However, eventually, as the book explains, when done right – Fitness and Diet, the weight will fall in place. That is my premise in the book.

I have seen too many women fall prey to clever marketing, advertising promising perfect bodies ……. if only they subscribe to a dubious product, procedure and so on. Of course, the women concerned are to blame too. They WANT the easy way out. They DO NOT WANT to be questioning these claims that promise miracles. They are constantly making excuses for themselves. They play the VICTIM ROLE very well, leaving their health and bodies to sheer chance and circumstances and under other peoples control.

As is very clear I am totally against women relegating control of their bodies to others or to society. I think they need to sit up and take notice of themselves. Prepare to be shocked or pleasantly surprised with what they see in themselves and then, make the necessary changes to progress not regress!! This seems to be extremely hard to do for many. It is much easier to go to, lets say a dietician or trainer and have her draw up meal plans or exercise routines for drastic results. Have her take responsibility for the success or failure of the person concerned in ‘losing weight’. If there is no weight loss, then the dietician/ trainer is to blame. They are uninterested in the ‘why’, unacceptable of their own responsibility and unwilling to question what is being recommended. They are not concerned with the long-term effects as long as there are short-term results. They choose to believe what suits them rather than try to sieve the wheat from the chaff. So for instance, if someone recommends ‘drink lemon and honey first thing in the morning’ to ‘burn’ fat, they would much rather believe that than – ‘exercise first thing in the morning’!

I believe women need to be more proactive with their choices about their bodies. They need to be more discerning about their long-term health and not just short-term cosmetic results. They should not fall prey to societal pressure to look a certain way. It is not always possible to get to a ‘certain size’. A lot depends on genetics and environment especially lifestyle, stress, work and so on. Comparing one with other women who one perceives to be ‘beautiful’ or ‘slim’ is a futile exercise.

Every woman is beautiful in her own way. She can also be the best possible version of herself physically by applying some basic principles of diet, exercise and healthy living. By challenging herself intellectually and creatively, she then can proceed to live a fuller more fruitful life.

Women are more likely than men to allow emotional challenges to affect their eating, weight and health. Crisis in relationships or work can set one to start abusing food and ultimately their bodies. Binge eating, anorexia, bulimia are all psychological disorders with a basis in ones lack of self-esteem and a troubled consciousness. Women are also more concerned about how society views their physical appearance. This would translate as them trying all means possible to ‘look’ a certain way. This self-defeating attitude can be highly corrosive to ones self-esteem.

You should ultimately want to look a certain way for yourself and not for society. No doubt, that societal influence is great even while making that choice. For instance, in the early 16^th century a more voluptuous figure was considered beautiful. Today in the 21^st century, such a body would be considered ‘fat’. The point is, should you try to attain a certain ‘look’ because it is expected of you? More importantly, what happens when you cannot achieve that look? Does it make you a worse person? Not at all.

Women have to understand that they are truly more than their weight on the scale. They cannot evaluate their life by a mere number. Yes there are a several reasons (not just cosmetic) why being overweight is not recommended, and why losing fat is advised. The reason to lose weight therefore should be more focused on health than mere looks.

Certainly, if you believe that just losing weight will make you feel better about yourself, you may be in for a surprise! You may feel ecstatic initially after losing the weight. This is because of the sense of achievement, the admiration and applause from others and what you see in the mirror. After a while however when this palls and when the complements fade, you still need to find a reason to continue to exercise and eat healthy for yourself. You still need the self-motivation to keep going with your fitness routine. You need to find those resources from within yourself and if you are lucky, from encouraging friends. This is what makes for a success story and for the difference between short-term weight loss and long-term achievements.

One has to understand that Fitness is a Journey, not a Destination. Being Fit is not just about being a certain Size, but an improved level of Performance of the Body and a Superior Quality Life.

This is the only way to persist with a fitness routine and healthy eating, day after day, week after week. Sometimes, even when you don’t want to. Sometimes, when you are lazy. Sometimes, when you just don’t see any reason to! It is the understanding of this journey that keeps you experimenting, progressing and enjoying the process enough to persist with it for as long as you possibly can.

It becomes a way of life. It becomes so much a part of your day that it is no more an ordeal to exercise. It is your way of saluting your body. Of respecting it. Rewarding it for being there for you!

These are the ideas that I hope will permeate the lives of those who read my book, “Get Size Wise”. I hope to make them love their bodies more. Be thrilled, amazed and appreciative of it. I also hope to make them stop abusing it with food or lack of exercise. I hope to help them understand that they ARE already beautiful but can become even better versions of themselves if they only try.

Warmly

Sheela