1.DR.MANINDER AHUJA AHUJA NURSING HOME & INFERTILITY CENTRE SECTOR 17 FARIDABAD Vice President FOGSI(Elect 2013 ) Secretary General IMS Chairperson Mid Life Management Committee FOGSI Web site and E-connect Co ordinator SAFOMS President Faridabad Obst.&Gyne Society Founder Chapter Secrertary IMS Faridabad Chapter Secretaty women wing Haryana State IMA (past) PUBLICATIONS: Step by step management of Menopause Many chapters in many publications and books Author of 3 DVDs On Exercise.ON PANEL WITH AIMS , METRO HOSPITALS AND SARVODAYA HOSPTIAL

2. How to slow down the hands of time? Control weight gain and exercise Dr.Maninder Ahuja Director Ahuja Hospital &Infertility Centre setor 17 FBD 3. WOMAN IS THE PIVOT OF UNIVERSE! Woman is the axle around whom the family, society nay! The whole universe is revolving .So her health is of utmost importance at all stages of life more so in Menopause.Dr.Maninder ahuja02/11/144 4. Health issues Why important? Life expectancy is increasing!!! Remember - in 1900 people were considered old in their 40s; just 40 years ago people seemed old in their 60s; but today many do not feel old in their 80s a phenomenon and we say never feel old and remain walking till the final recall! From 30 yrs to 76 years Dr.Maninder ahuja02/11/145 5. POPULATION PYRAMIDS 6. QUALITY OF LIFE IS IMPORTANT In these Golden Years she wants to have her own identity!AAJ PHIR JEENE KI TAMMANNA HAI , AAJ KUCH KARNE KA IRADA HAI!!!!!!! Dr.Maninder ahuja02/11/147 7. WE ARE CHANGING CONCEPTSDOCTOR: A person who kills your ills by pills, and kills you by his bills! Change from pill doctors Change from pill doctors Preventive health Preventive health 02/11/14Dr.Maninder ahuja8 8. FIT AT FORTY STRONG AT SIXTY AND INDEPENDENT AT EIGHTY !!Dr.Maninder ahuja02/11/149 9. Physical Problems Slowing us down Vaso motor symptoms Hot flushes Mood changes Sleep disorders Musculo Skeletal Sarcopenia Osteoporosis Joint aches and pains osteoarthritisMetabolic syndrome Cardiac problems Hypertension Obesity Cardiorespiratory Long term Longevity Cancers Alzheimer 10. FACT SHEET Worldwide obesity has more than doubled since 1980. 65% of the world's population live in countries where overweight and obesity kills more people than underweight. More than 40 million children under the age of five were overweight in 2010.Obesity is preventable. 11. CHANGING TIMES 12. Which one is Quality life?Dr.Maninder ahuja02/11/1413 13. Purpose of presentation Sensitization about QOL Issues Different life style modifications Different types of exercises Intensity of exercise Duration of exercise Frequency of exercise Different types of diet. Carry home message 14. A SMALL TRUTH TO What makes life 100% MAKE LIFE 100% A small truth to make life 100% and enjoyable!02/11/14Dr.Maninder ahuja15 15. 02/11/14Dr.Maninder ahuja16 16. Hard Work H+A+R+D+W+O+R+K 8+1+18+4+23+15+18+11 = 98% Knowledge K+N+O+W+L+E+D+G+E 11+14+15+23+12+5+4+7+5 = 96% 02/11/14Dr.Maninder ahuja17 17. Love L+O+V+E 12+15+22+5 = 54% Luck L+U+C+K 12+21+3+11 = 47% ( don't most of us think this is the most important ??? ) 02/11/14Dr.Maninder ahuja18 18. Then what makes 100% ? Is it Money ? ... NO ! ! ! M+O+N+E+Y 13+15+14+5+25 = 72% Leadership ? ... NO ! ! ! L+E+A+D+E+R+S+H+I+P 12+5+1+4+5+18+19+9+16 = 89% 02/11/14Dr.Maninder ahuja19 19. ATTITUDE A+T+T+I+T+U+D+E 1+20+20+9+20+21+4+5 = 100%It is OUR ATTITUDE towards Life and Work that makes OUR Life 100% ! ! ! 02/11/14Dr.Maninder ahuja20 20. Keep laughing ! 21. Throw out all non essential Numbers That includes Age What number you should be careful about is your weight and WHR 22. So to slow down hands of time We have to change our attitude !B + 23. Cherish your health:Your first Temple is your Body! If it is good, preserve it. If it is unstable, improve it. If it is beyond what you can improve, get HELP ! 24. The rise of non communicable diseases in India 25. Harmful effects of obesity Increased risk of Heart disease, High blood pressure Diabetes Cancer of uterus, cervix and breast cancer and some other cancers Osteoarthritis Recovery poor after surgeries and cancer treatment Sleep apnea and sleep problems QOL Logevity decreased Poor body image Depression 26. Causes of obesity Can be continous from adolescents Around perimenopause 27. What worries you most ? External appearance ? Over all fitness? Both ? 28. External appearance Can be arranged by spending money but for a limited time only. Cosmetic surgeries Laser Botox Collagen fillers basket full ! 29. SYNCHRONIZATION OF FACE AND BODY 30. What is happening? Obesity (BMI)in adult women rises significantly each decade, until it begins tapering off late in life in seventies.on average gain 2.5kg. Increased central adiposity during menopause Fat increases &lean muscle mass decreases 30% to 40% relative to total body mass as we age. Altreration in waist hip ratio Decrease in BMD,peak till 35 yrs. 5-05-2007Dr.maninder ahuja 31. The perimenopause and body composition A more rapid increase in fat mass Redistribution of fat to the abdomen Transition from a gyncoid to an android pattern of fat distribution and an increase in total body fat and increased risk of Metabolic syndrome11/02/14drmaninder ahuja NARCHI32 32. SARCOPENIA-what you cant see GOOD LEAN MASS5-05-2007SARCOPENIADr.maninder ahuja 33. Leisure time increases 34. Ideal weight and WHR For asians For others BMI of 18-23normal. (20-25 ) BMI of 23-28 is overweight (2530) BMI of over 28 is obesity (>30) BMI of over 35 is morbid obesity BMI is Wt.in Kg /ht in sqM 5-05-2007 Dr.maninder ahuja 35. 11/02/14drmaninder ahuja NARCHI36 36. BMI CALCULATING CHARTS 37. WEIGHT CONTROL BY CALORIE RESTRICTION Caloric restriction, the centerpiece of weight-loss efforts for most women, decreased BMR and loss of fat free mass. NO!!! Because the resting metabolic rate accounts for nearly two thirds of total caloric expenditure and muscle mass accounts for 20%of REE 5-05-2007Dr.maninder ahuja 38. Weight loss Is it a losing battle?Dr.Maninder ahuja02/11/1439 39. MOTIVATION!Dr.Maninder ahuja02/11/1440 40. Three types of diets After losing 10% to 15% of body weight during a run-in phase, participants were allocated to a low-fat diet (20% fat, 60% carbohydrate, 20% protein), a low-glycemic-index diet, and a very low-carbohydrate diet (10% carbohydrate, 60% fat, 30% protein) in random order, each for four weeks. The primary outcome was resting energy expenditure with secondary outcomes of total energy expenditure, hormone levels, and metabolic syndrome components. 41. Effects of energy expenditure Those on the low-carb diet burned 350 calories per day more than those on the low-fat one, even though they consumed the same amount of calories on all these diets. That's equivalent to one hour of moderate-intensity physical exercise And those on the low-glycemic-index diet lost about 150 calories per day more than those on the low-fat one, "equal to about an hour of light physical activity,( 42. Strongest support for concept that not all calories are the same Low-carb diet : increases in CRP, a measure of chronicinflammation, and 24-hour cortisol, the key stress hormone, "suggesting that any initial advantages were eroded over time by these biological stressors, Low-fat diet :as well as resulting in the least energyexpenditure"exacerbated many of the components of the metabolic syndrome, so insulin resistance, triglycerides, and HDL cholesterol were all worse on this diet,LOW GYLCEMIC INDEX DIET IS BEST 43. Diets 44. SUGARS?????? 45. Smoking is bad !! 46. Dynamic Duo ! 47. Role of Vit DSerum 25 D should be 80 nmol/L or higher Low levels of vitamin D are highly prevalent Vitamin D plays a key role in normalizing PTH levelsVitamin D deficiency is associated with increased risk of falls and fractures,vitamin D intakes much higher than are currently recommended are quite safe.Raising serum 25(OH)D from 50 to ~80 nmol/L improves Ca absorption, raises BMD, and reduces both fall and fracture risk02/11/14Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI50 48. Vit D Def & Risk Of Falls02/11/14Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI51 49. Role of calcium 1200-1500 mg/day and Vit 800 IU is undisputed,low salt,low sugar and fat and low High GI Carbs but high fibre 50. The ABC of Physical Activity for Health: a consensus statement from the British Association of Sport and Exercise Sciences. 51. Recommendations for total activity All healthy adults aged 18-65 years should aim to take part in at least 150 min of moderate-intensity aerobic activity each week or at least 75 min of vigorous-intensity aerobic activity per week, or equivalent combinations of moderate- and vigorous-intensity activities. Muscle training two or three times a week 52. Beginners Beginners should work steadily towards meeting the physical activity levels recommended for all healthy adults like increasing 10 min of activity every other day for several weeks They should enjoy 53. Conditioned individuals Conditioned individuals who have met the physical activity levels recommended for all healthy adults for at least 6 months may obtain additional health benefits by engaging in 300 min or more of moderate-intensity aerobic activity per week, 150 min or more of vigorous-intensity aerobic activity each week, or equivalent combinations of moderate- and vigorous-intensity aerobic activities. Those who want to lose weight or like diabetes should go beyond health goals for adults along with calorie restriction 54. Weight gain in midlife less if started early Our bodys metabolism slows as we age, but moderate to vigorous exercise can counteract this decline by lessening weight gain. Those who begin moderate to vigorous physical activity in their 20s and continue through middle age gain less weight. Women particularly benefited from 20 years of high activity, gaining on average 13 pounds less than those with low activity, says the study. 55. BANKING OF GOOD HEALTH HAS TO START FROM ADOLELSCENCE02/11/14dr.maninder ahuja60 56. It is for you to decide now if you want One with stick, one with wiper!5-05-2007Dr.maninder ahuja 57. Structured daily routine activities11/02/14drmaninder ahuja NARCHI62 58. Fat loss is all about long-term goals HOW LONG EXERCISE? It takes 20 minutes for an unconditioned person to actually start burning fat. An average conditioned person will take about 10 minutes Aim is 45 min/day It takes a fit person about 11 sessions of a 45minute fat-burning exercise period to burn 1lb of fat, which is 3,500kcal.02/11/14Dr.Maninder ahuja63 59. Despite all these if you have 60. Weight lifting is good ! 61. Components of fitness Exercise is designed to improve the five key components of physical fitness: Cardio-respiratory endurance, Muscle strength and loss of bone mass muscle endurance, Flexibility and stretching exercises are like yoga, taichi Body composition. 02/11/14Dr.Maninder ahuja66 62. Types of exercises Aerobic like walking, swimming, cycling, dancing, taichi, yoga for burning fat Range of motion or Stretching exercises like Pilatees,yoga Weight training & resistive exercises build up the muscles and tendons that support your joints Mindful exercises like meditation02/11/14Dr.Maninder ahuja67 63. Stretching exercises 64. Exercises Stretching exercisesResistance and weight bearing 65. Strength training in osteoarthritis AFTER 12 WEEK ST TRAINING PROGRAMME Balance improved by 55 % Muscle strength increased by 14 % Flexibility improved by 17% Self-reported pain decreased by 30% Tibial cartilage volume increased. 2007 Current Medicine Group Ltd, a part of Springer Science+Business Media02/11/14dr.maninder ahuja70 66. You need stamina for walking!02/11/14Dr.Maninder ahuja71 67. INTENSITY OF EXERCISE Moderate to severe in intensity How to know about intensity MHR : 60-80 % of MHR and MHR is 220 _ age in yrs. At 50 yrs 220-50 = 170 and 60 % is 102-136 Borg test of SPE Talk test02/11/14dr.maninder ahuja72 68. SOME GUIDELINES Learn proper way of stair climbing Split it up ,use pedometre U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf 69. DANCING IS BEST AEROBIC EXERCISE 70. What are resistance and wt training exercises To build up your strength and stamina To increase your BMD To prevent and REVERSE sarcopenia Mood elevation Increased libido Less cancers After cancers QOL Better 71. Integrated into your life style! 72. AS A LAST RESORT !! 73. If you want to be free and flying! &make the journey of life beautiful! Come and exercise ,change attitude ,eat properly!!!! You don,t have to lose anything except your fat!02/11/14Dr.Maninder ahuja80 74. Tell the people you love that you love them, at every opportunity..Life is not measured by the number of breaths we take, but by the moments that take our breath away 75. Be together and keep dancing! 76. Don,t be left behind! Turn back the clock !!!!! , , , , 02/11/14Dr.Maninder ahuja83 77. 02/11/14dr.maninder ahuja84