exercise requirements

Time to move it, move it

Your Health

Dr Gita Mathai Dec 20, 2017 00:00 IST

You need to exercise regularly to maintain health, prevent weight gain, delay the onset of lifestyle diseases such as diabetes and hypertension, slow mental decline and even avert some cancers. It is essential for correct posture, restful sleep and a good mood. After an hour of working out, no problem seems insurmountable. The question, however, is "Just how much exercise is enough?"

Originally, 70 years ago, 10,000 steps per day was considered sufficient to maintain health. That translates to 5 miles or 8 kilometres. A sedentary person, who works at home or in an office, averages 1,500 to 3,000 steps a day.

People want to be fit. These publicised step statistics led to increased sales of wearable fitness devices, which calculated the number of steps taken. People became fixated on numbers and tried to frantically complete the requirement before bed.

After a series of studies, the number of steps needed per day to maintain health has been increased from 10,000 to 15,000. Usually, we take 100 steps a minute when we are walking fast. At this speed, it is possible to have short bursts of conversation. During speed walking or jogging, we take around 130 steps per minute. This means a person would need to walk for little more than two hours for 15,000 steps. Many of us cannot spare that much time!

Fortunately, continuous short bursts of activity throughout the day are also beneficial and more likely to result in sustained weight loss and fitness. After an intense 30-minute walk or run, if you sit at your desk the rest of the day (eight hours), you are unlikely to reach your 10,000-15,000 steps a day target. Also, despite all the effort, your lifestyle will be classified as "sedentary", with all its accompanying risks.

Hitting the gym is a popular concept among the fitness conscious. Unfortunately, studies show that gym memberships in India are more expensive than in Australia or the US. The timings are often inconvenient and the commute problematic. Motivation often dips after a few months. Since many gyms insist on advance payment for the whole year, money is often wasted.

Walking on the road is free. It is also possible to draw a figure of 8 on the terrace or the living room and walk for 30-40 minutes.

In addition to active exercise, muscles strength can be achieved with resistance exercises using dumb bells - 2kg for women and 5kg for men. This helps build muscle mass to support back, abdomen, knees, chest, neck and shoulders. Strong muscles speed up metabolism and increase endurance. Core exercises strengthen the spine, so you are less likely to suffer from degeneration, slipped discs and backache. Strong muscles burn calories faster and more efficiently, helping with weight loss.

Both the body and mind need healthy activities. Regular exercise releases chemicals from the leg muscles that keep the brain active. Irregular sleeping hours, late night television and texting take a toll on health. These produce a sluggish brain and a craving for unhealthy fatty foods, starting you off on that vicious circle of fighting weight gain again.

METABOLIC METER

• Have a heavy, protein-rich breakfast to give metabolism an early start

• Coffee, regular and green tea are also metabolic enhancers

• Skip the second drink to stop your metabolism turning sluggish

• Make weight training a part of your exercise regime to maintain muscle mass, which burns more calories than fat

exercise

how much exercise

Time to move it, move it

Your Health

Dr Gita Mathai Dec 20, 2017 00:00 IST

You need to exercise regularly to maintain health, prevent weight gain, delay the onset of lifestyle diseases such as diabetes and hypertension, slow mental decline and even avert some cancers. It is essential for correct posture, restful sleep and a good mood. After an hour of working out, no problem seems insurmountable. The question, however, is "Just how much exercise is enough?"

Originally, 70 years ago, 10,000 steps per day was considered sufficient to maintain health. That translates to 5 miles or 8 kilometres. A sedentary person, who works at home or in an office, averages 1,500 to 3,000 steps a day.

People want to be fit. These publicised step statistics led to increased sales of wearable fitness devices, which calculated the number of steps taken. People became fixated on numbers and tried to frantically complete the requirement before bed.

After a series of studies, the number of steps needed per day to maintain health has been increased from 10,000 to 15,000. Usually, we take 100 steps a minute when we are walking fast. At this speed, it is possible to have short bursts of conversation. During speed walking or jogging, we take around 130 steps per minute. This means a person would need to walk for little more than two hours for 15,000 steps. Many of us cannot spare that much time!

Fortunately, continuous short bursts of activity throughout the day are also beneficial and more likely to result in sustained weight loss and fitness. After an intense 30-minute walk or run, if you sit at your desk the rest of the day (eight hours), you are unlikely to reach your 10,000-15,000 steps a day target. Also, despite all the effort, your lifestyle will be classified as "sedentary", with all its accompanying risks.

Hitting the gym is a popular concept among the fitness conscious. Unfortunately, studies show that gym memberships in India are more expensive than in Australia or the US. The timings are often inconvenient and the commute problematic. Motivation often dips after a few months. Since many gyms insist on advance payment for the whole year, money is often wasted.

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Walking on the road is free. It is also possible to draw a figure of 8 on the terrace or the living room and walk for 30-40 minutes.

In addition to active exercise, muscles strength can be achieved with resistance exercises using dumb bells - 2kg for women and 5kg for men. This helps build muscle mass to support back, abdomen, knees, chest, neck and shoulders. Strong muscles speed up metabolism and increase endurance. Core exercises strengthen the spine, so you are less likely to suffer from degeneration, slipped discs and backache. Strong muscles burn calories faster and more efficiently, helping with weight loss.

Both the body and mind need healthy activities. Regular exercise releases chemicals from the leg muscles that keep the brain active. Irregular sleeping hours, late night television and texting take a toll on health. These produce a sluggish brain and a craving for unhealthy fatty foods, starting you off on that vicious circle of fighting weight gain again.

METABOLIC METER 

• Have a heavy, protein-rich breakfast to give metabolism an early start

• Coffee, regular and green tea are also metabolic enhancers

• Skip the second drink to stop your metabolism turning sluggish

• Make weight training a part of your exercise regime to maintain muscle mass, which burns more calories than fat

neck pain

Keep pain away - Your Health First published on 13-Dec-2017 Dr Gita Mathai  Many people suffer from pain in the neck, sometimes radiating down to the shoulders and arms. This used to be a disease of middle age. Now, young adults and even 11-year-olds complain of stiffness and pain. The human head weighs around five kilograms, approximately 8 per cent of total body weight. Seven neck bones (cervical vertebrae) support this relatively heavy head. These bones are the smallest and weakest of all the vertebrae. They are separated by natural "washers" - little gel-like discs that act as shock absorbers and provide stability, flexibility and motility. In childhood, the discs are composed of 85 per cent water. As age advances the water content decreases. The brittle discs can then break open, herniate or develop cracks. Damage heals poorly as the discs do not have good blood supply. The vertebrae come closer and the alignment is disturbed. The nerves to the shoulders and arms come out from between these bones. They can become pinched, causing pain and stiffness. In people over 40, 60 per cent of X-rays show degenerative disc disease. Not everyone is, however, symptomatic. Pain can appear gradually or suddenly. It is usually sharp like an electric shock and runs down the arm. The doctor makes a diagnosis from a physical examination, X-rays, and CT and MRI scans. Vitamin D, calcium and phosphorous levels should be checked to see if the problem started due to bone weakness. Treatment involves pain relieving gels, heat and ice. A soft neck brace can be worn intermittently, especially during travel. Physical therapy is the mainstay of treatment. It helps to strengthen the neck muscles so that the bones are held in place even if there is degeneration. Flexion and stability exercises improve the function of the neck. Traction, massage and manipulation may be used. Pain relievers, anti-inflammatory drugs and anti-spasmodics can be tried. Surgery to remove the offending disc is usually the last resort. School-going children with neck pain often have faulty posture while sitting in school, studying at home, watching television, or using cellphones and computers. They slouch, lean too far forwards, sit sideways, refuse to use the tables provided and manage to strain their neck muscles. In addition, they carry heavy schoolbags, often slung asymmetrically on one shoulder. As per government guidelines, the weight of a schoolbag - including all books - should not exceed 1.5kg before Class III, should be 2-3kg for classes III to V, 4kg for classes VI and VII, 4.5kg with regard to Classes VIII and IX and not more than 5kg for Class X. Unfortunately, these guidelines are seldom followed. In young adults, the commute to college or workplace may be a long one. While seated on a bike, the back should be straight. In a car, the distance between the seat and the steering wheel should be adjusted so that the arms are slightly flexed. While using a computer or watching television, the screen should be at eye level. Taking these precautions could save your neck. To prevent neck strains, pains and degeneration Maintain ideal body weight (height in meter squared X23) • Do regular flexion and stretching exercises. Yoga is ideal. • Maintain good posture while sitting and standing with shoulders straight and feet flat on the floor. • Do not use a high pillow while sleeping.

anemia

Blood debt Dr Gita Mathai Statistics say that about half of the Indian population, across age groups, sexes and economic strata, is anaemic. Since anaemia - a condition when a person does not have enough healthy oxygen-carrying red blood cells circulating in the body - affects both the efficiency and endurance of a person, you have to get rid of it if you want to realise your full potential. The initial symptoms of are vague and non-specific - lack of energy, unexplained mental and physical fatigue, giddiness, headache, low body temperature and pallor. Pregnant woman and children may develop a perverted appetite (pica) with a desire to eat things such as clay, chalk, bricks or ice. Anaemic women can have stillbirths or small unhealthy babies, and even die during childbirth. Anaemic children are smaller than their peers and have impaired cognition and problem solving skills. They perform poorly in school. They also have frequent respiratory and intestinal infections. All the organs in the body require oxygen to function efficiently. As the anaemia worsens, the supply of oxygen lessens. Signals are sent to the heart, which has to pump harder to get sufficient oxygen to all organs. This can result in abnormal rhythms and even heart failure. The most common cause of anaemia is deficiency of iron. Iron is present in lean meat, poultry and seafood. Vegetarians can get iron from lentils, legumes, soya products and nuts. Plants contain relatively less iron and much of it exists in combination with organic compounds called phytates, which making absorption difficult. Anaemia can also result if there is sudden or chronic blood loss, like in heavy periods, piles or haemorrhoids, gastric or duodenal ulcers, or even worm infestation. In the case of chronic illnesses such as kidney or liver disease or heart failure, the body just may not produce enough red blood cells. This is called the "anaemia of chronic disease". Production may be affected by lack of vitamin B12 or folic acid. Sometimes the bone marrow shuts down and does not produce red blood cells, a condition called aplastic anaemia. This may occur due to radiation, exposure to toxins or as a reaction to certain medications. In some inherited conditions such as thalassaemia or sickle cell disease, the haemoglobin in the red blood cells is faulty. Anaemia is confirmed with blood tests to determine the haemoglobin levels. Normal values is usually 13.7 g/dl in males, 12 g/dl in females and 11g/dl in children. Sometimes, vitamin B12 or folate levels, a bone marrow aspiration or haemoglobin electrophoresis may be required. Gita Mathai is a paediatrician and author of Staying Healthy in Modern India . Mail your questions on health issues to yourhealthgm @yahoo.co.in

 

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diabetic control

Diabetic control
The patient’s blood sugar refused to go below 400 no matter what I tried.
“I think I might have to start you on insulin.”
“Aren’t those injections,” she said ,”and I have to poke myself around my stomach?”
“Well---” I said. 
Before I could finish she said accusingly, “It is all because of your diet.”
“My diet?” I asked bewildered. I had calculated a nice 1500 calorie diet for her based on the family’s normal food intake.
“You told me to eat two iddlies in the morning, , one cup of rice in the afternoon and 2 chappatis for dinner. In the morning, after my pongal and vadai I find it difficult to eat two more iddlies. At lunch time, I have variety rice. Then I swallow your one cup of plain rice with sambhar. “
She must have been eating at least 5000 calories a day!
“What about the morning walk?” I asked.
“How can I walk? Where is the time? I have to cook the families’ food and then the extra diet you have prescribed for me!”
I was bereft of speech.
Another woman with persistent blood sugar level of 375 told me “I eat two iddlies for breakfast lunch and dinner. I love iddlies.”
I was puzzled. Then her daughter-in- law came with her .
“My mother-in-law makes delicious iddlies, “ she said slyly, “I brought two for you.”
I simpered and said, “Oh, you needn’t have.”
Then I saw the iddlies. They had been steamed in a large aluminum strainer similar I usually use to wash vegetables and fruits. They were 9 inches across and two inches thick.

As I started screeching at the patient, the daughter-in-law smirked in the background, preening herself.

Now I have started saying,
“House work is not exercise. You have to walk for 40 minutes on an empty stomach. You cannot eat anything I have not written in the diet sheet. You can eat only ‘cooker iddlies.’
Hope that works!

strokes

Stroke alert https://www.telegraphindia.com/1170918/jsp/knowhow/story_173704.jsp

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Your Health - Dr. Gita Mathai

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The Indian population is now aging, and non-communicable diseases - basically lifestyle diseases - such as diabetes, high lipids and hypertension are prevalent. While those suffering from such diseases are usually correctly diagnosed, the disease itself is often inadequately controlled. Sometimes, patients skip medication during fasting (for religious events), or else they "forget" or there is a few days delay in replenishing the exhausted stock of pills. Lifestyle modifications (diet and exercise) are ignored or inadequate. This means that the sugars, the blood pressure and the lipid levels can go up and down like a rollercoaster. This causes catastrophic events such as a stroke.

In developed countries, strokes - a clot or bleeding in the brain - occur around the age of 65 but they occur around 15 years earlier in India. Also, earlier it was thought that only men were at risk but now more and more women are suffering strokes. Major risk factors include diabetes, hypertension, alcoholism and tobacco use. Now, the fad of fast food (laden with trans fats) and diet drinks have added to the risk.

A stroke occurs when blood supply to a part of the brain is compromised or completely cut off. Blood supplies oxygen to the brain, without which brain cells die. The symptoms of a stroke depend on the area of the brain affected, the extent of the damage and whether the blood supply is partially or completely affected. Partial symptoms may occur intermittently for days or weeks. At that time, if the symptoms are recognised as TIA (Transient Ischaemic Attacks) it is possible to treat the precipitating factor and prevent progress to a full blown stroke. Unfortunately, TIAs may not be taken seriously as they pass off spontaneously and recovery is complete.

Blood supply may be compromised because blood vessels in the brain have become narrow or blocked by fat deposits, or a clot (embolus) produced somewhere else in the body has travelled to the brain via blood. It can also be due to a bleed into the brain. This may be cased by to congenital malformations in the blood vessels of the brain leading to it suddenly bursting. Damage may also occur because of trauma to the head, when blood collects in the space around the brain.

The symptoms of stroke include headache, drowsiness, loss of consciousness, clumsiness, confusion, loss of memory, dizziness, loss of bowel and bladder control, weakness or paralysis of a limb or one part of the body, difficulty in swallowing and loss of balance.

A stroke is a medical emergency. Good results are seen if treatment is started within three hours. If the stroke is due to a block in one of the arteries supplying the brain, emergency treatment with a tablet of Aspirin should be given at home. (This is contraindicated if the stroke is due to a bleed). The potent clot busting drug TPA (Tissue Plasmogen Activator) can be given intravenously. Blood clots can be surgically removed. Blood thinners and anti clotting medication can be administered, sometimes directly into the brain. Narrowed vessels can have stents placed in them to open them up. Bleeding blood vessels can be surgically clipped. Risk factors like diabetes, hypertension and high lipids can be treated. Irregular heart beats can be medically corrected.

The human brain is a remarkable organ. It is possible to lead a fairly normal life with a damaged brain. About 70 per cent of stroke patients manage to achieve this. Undamaged areas compensate and take over required activity . Much of this requires expert training, with close co-ordination between physicians, physiotherapists and occupational therapists, as people relearn how to walk, swallow, speak and co-ordinate arm and leg movements. Rehabilitation is the key to stroke recovery.

The writer is a paediatrician with a family practice at Vellore and author of StayingHealthy in Modern India .

If you have any questions on health issues, please write to yourhealthgm@yahoo.co.in

panic attacks

One of my patients, a middle-aged mother, regularly turns up at emergency chest pain ICUs with a "heart-attack". She develops trembling, giddiness, hyperventilation (rapid breathing), tingling in the hands and, most frightening of all, palpitations, chest pain and sweating. During an attack, she looks like she would collapse. Each time, after spending a fortune, she is sent home in 24 hours with the good news that she did not have a heart attack. She is fortunate that none of the centres she visited advised her to go in for an angiogram, angioplasty or offer her by-pass surgery.

What she actually had were classic "panic attacks" that were rapidly progressing to a "panic disorder". These attacks can start in childhood, when it may not be recognised as such, be present through adolescence and become incapacitating in adult life. It is more likely to affect women.

A panic attack is an exaggerated version of the body's normal "flight or fight" reaction to danger. The difference is that the chemicals and hormones causing the physical symptoms are released when there is no perceivable threat. Some people are more vulnerable to these chemical changes in the blood. This sensitivity can run in families. It may be in response to difficult changes in life, such as loss of a loved one, birth of a child or a change or loss of a job. It can also occur for no known reason.

These symptoms are not always caused only by a panic attack, they can also be due to smoking, consumption of excess caffeine (coffee, tea, cola, energy drinks, health supplements, weight loss products), some prescription and OTC medications, and cough mixtures as well as diseases, such as an over active thyroid gland, or cardiac issues like mitral valve prolapse or intermittent irregular heartbeats.

So before you dismiss such an episode as a panic attack, make sure the patient has a through examination and relevant tests done to rule out other reasons that could have led to the symptoms. These causes are usually treatable.

It is normal to have one or two panic attacks in a lifetime, especially if precipitated by major stress. However, if the attacks are frequent and for no reason, it is classified as a panic disorder and requires treatment. Otherwise, the person may start avoiding social situations or refuse to leave the house. He or she cannot function normally and may become depressed or suffer from other psychiatric disorders.

Sometimes you can stop panic attacks by making simple lifestyle changes.

• Have 4-6 helpings of fruits and vegetables a day. The antioxidants and flavonoids in these help control symptoms.

• Eat meals on time. This prevents jitteriness from low blood sugars.

• Avoid junk food.

• Limit caffeine and alcohol intake.

• Stop smoking

• Take a brisk walk or jog for 40 minutes in the fresh air everyday. This releases chemicals from the calf muscles that negate the panic causing chemicals.

• When the attack occurs, close your eyes and take deep breaths to slow the heart rate.

• Do yoga daily, concentrating on stretching and breathing.

• Meditate for 10-20 minutes a day.

Medication is required when panic attacks do not respond to lifestyle changes. Anti-depressants are effective but may have to be continued for several months. They may be prescribed along with sedatives to help relaxation. Unlike anti-depressants, some sedatives can be habit forming so they should be taken for only a short time.

Improvement takes time. Patience is the key. Maintain a diary and record the frequency of symptoms. It is important not to alter medications or dosage (stop, increase or decrease) without the doctor's permission. Medication works best when combined with psychotherapy. Regular sessions with a counselor may help.

Dr Mathai is a paediatrician and author of StayingHealthy in Modern India. Mail your questions to rhealthgm@yahoo.co.in

not twins

That sounded logical. I was not sure of the family planning rules, which seemed to change every now and again.
The government frequently said things like, “You will get money if you get sterilized after two children, sometimes “only if both are girls”, sometimes, if you got “sterilized after one child.” I had stopped keeping track. Nothing seemed to deter the ones who wanted more children. Not money or threats.
She kept bringing the first child. His health was poor, he was underweight, his nose dripped constantly and he had a vacant adenoidal stare. He was a wheezer. A week or two after treatment his weight always picked up, his mouth remained closed, the dripping was better, but he then he had diarrhea. Then we would be back to square one. Once the diarrhea recovered, he would start wheezing again.
Once she came and said, ”can you see me out of turn? The taxi is waiting. We have to go for a wedding. He has diarrhea.”
I looked out of my window to see if she was telling the truth. I saw four identically dressed boys of marginally different sizes.
“Who are these ?’ I asked.
“They are mine.” She said.
But there are four----.
She looked sheepish. My husband said you would get angry if we had four boys and I have not had a sterilization. We registered the first and second with the same name.”
I thought of my consternation and bewilderment each time he/ they came with their weights going up and down like a yo-yo. In my records they both had the same name and birth date, but were actually 11 months apart!
I don’t know who I was investigation for eosinophilia, anemia, milk intolerance, adenoids, failure to thrive!!!
“Why? Why?” I asked.
“We want a girl---“
I

gait

https://www.telegraphindia.com/1170821/jsp/knowhow/story_168290.jsp

Talk the walk

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Your Health - Dr. Gita Mathai

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As infants grow, their motor skills develop in a certain set, sequential pattern. They first turn over, then sit, crawl, stand and walk. Some give the crawling stage a miss. Others, very efficient at crawling, may learn to walk later. Most children are mobile by 14-16 months of age.

The first steps of a baby are wide-based, wobbly, short and rapid with the arms outstretched for balance. Like every activity, walking improves with practice. Though falls are frequent, they need not be feared unless they are from a height or down steps.

The adult gait is different. The heel of one leg first touches the ground then the whole foot is placed flat. The heel then rises, the weight is transferred onto the toes. The body swings off the toes with arms swinging in a reciprocal manner. Children start to develop this gait around 18 months and perfect it by the age of eight.

Some children may have a "toe-in" gait, with the toes pointing inwards as they walk. Others may walk with a "toe out" gait. This may run in the family or be due to a cramped position in the uterus. This seldom interferes with running or sports activities. Some children walk on their toes.

As children get older, their posture, muscle power, and control spontaneously improve. The abnormal gait begins to correct itself. In toeing usually improves by the age of three, flat feet by six years, bow legs by 18 months and knock knees by seven years. There is cause for concern if the abnormality is not symmetrical and appears to affect one foot more, if it is accompanied by limping or pain, or if there are mental developmental delays.

Some gaits are definitely abnormal and need to be evaluated. Children may refuse to bear weight on one leg. They may complain of pain or there may be obvious shortening. The legs may swing forwards, remain stiff and spastic, and refuse to bend. The gait may remain wide-based and unstable. Faulty motor coordination due to neurological causes may produce an inordinately clumsy child who has frequent falls.

About 35 per cent of senior citizens have difficulty in walking half a kilometre or climbing one flight of stairs. The gait changes gradually in 60 per cent people; this is obvious in those 80 years or older. There is a reduction in speed of motion, the width and the length of the stride. A greater length of time tends to be spent with both feet on the ground. There is a tendency to remain bent with eyes fixed on the ground. This makes the gait appear cautious and shuffling. Weak hip muscles may make the gait "waddling."

This deterioration is not necessarily a natural consequence of aging, even though physically inactive people lose five per cent of muscle mass every decade. The change in gait may be due to weakness, but medication, diabetes, liver disease, the pain of arthritis, peripheral neuritis can also play a part. An unstable gait can lead to falls, injuries and fractures.

Any medical conditions causing gait problems should be targeted and treated. Physical therapy is helpful. During exercise, concentrate on the correct gait sequence: heel strike, flat foot, toe off. You should practise walking in a straight line, toe to heel walking, balance exercises, yoga, and pelvic and leg muscle strengthening. These interventions are effective if they are performed regularly four to five times a week.

Dr Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in