By Dr Anjali Sharma

What is Fitness ?

Physical fitness is defined as the ability to perform physical activity at optimum level up to sufficient period of time. It varies according to age, gender and health status of person. It can be judged by – 1) Kind of activity 2) Duration of activity 3) Intensity of activity 4) Observed & felt effects on body. It is a measure of efficiency of physical state. It consists of.

• Muscular strength & endurance
• Cardiovascular endurance
• Respiratory endurance
• Body composition
• Coordination & agility
• Flexibility
• Speed

Do I Need It ?

Fitness is the basic necessity for living. Poor fitness can affect working capacity, health, recreation, relationships and even day to day activities. Poor fitness takes away joy and zest of life. They are for everyone, irrespective of age and gender Fitness activities & exercises have been shown to give following benefits :

Fitness Assessment
Fitness assessment is must for various reasons like :

It involves

• Basic information - Age, gender, height, weight.
• Medical assessment – Any current or past sickness, family history of sickness. Basic clinical examination.
• Assessment of components of fitness – Cardiovascular endurance, respiratory endurance, muscle strength & endurance, body composition, agility, coordination, flexibility and speed.

Fitness Planning

Path To Fitness

1. Stamina Exercises – Also called aerobic exercises, these improve stamina of the body. These are especially good for cardiovascular function. Examples are walking, hiking, jogging, swimming, bicycling, roller skating, aerobic dancing etc.
2. Strength Exercises – These improve ability of musculoskeletal system to exert force called strength. Weight training and other Gym exercises.
3. Flexibility Exercises – These improve ability to flex, extend or circumduct joint through full range. These are helpful in correcting shortened muscles. Examples are yoga, static / dynamic stretching, PNF / CR / CA stretching method, fascial stretching etc.
4. Games & Sports - These improve various components of fitness. It is easy to maintain motivation in games and sports. Examples are tennis, badminton, squash, football, basketball, martial art, water sports etc.
5. Dancing – It is a unique way of fitness. It is fun and enjoyable..Examples are salsa, ballroom, jive, classical dance or even disco.
6. Others - There are number of other activities that help in improving fitness like Tai Chi, Qi Gong etc.
7. Cross-training – It involves creating an individualized program using multiple activities. This helps in taking care of various aspects of fitness, prevents boredom and fits well into lifestyle.

Exercise for Pregnant Women

It is better to improve fitness before planning for pregnancy and continue into it. There are many options available to improve fitness. Some are walking, light aerobics, yoga & stretching, pregnancy specific exercises like Kegel’s exercise, breathing exercises etc. 

What is Clinical Weight Management ?

Clinical Weight Management refers to all such changes and activities which are done to keep body weight within medically recommended range under clinical conditions. It can be dietary changes, changes in physical activity, changes in lifestyle, change in attitude & behavior, treatment of underlying medical condition etc. It can be done by self alone or in group. It is better done under trained professional and / or under medical supervision because if it is done in a wrong manner it can lead to impairment of health & diseases. Special caution is required in sudden, dramatic and magical weight loss which is a sure way to damage health. (See Precautions). Weight management is concerned with both over weight & under weight condition though in today’s world over weight is a bigger health challenge.

Why do I Need It ?
Over weight and obesity is major cause of health concern today. Obesity is defined as body weight exceeding 20 % or more of recommended weight range. This state of being over weight affects physical and mental health in many ways.

• It causes poor self image, causes depression and affects relationships.
• It affects functional capacity and efficiency at work, recreation and even day to day living.
• It plays a role in causing diseases like heart disease, hypertension, diabetes, arthritis, gall bladder disease, gout, respiratory insufficiency, stroke, atherosclerosis, varicose veins, pregnancy complaints, back pain, edema, poor sleep and even risk of some cancers.

Lose Weight But Not Health

If you are over weight, it is indeed recommended to lose that extra from your body. This is must for physical and psychological wellbeing. But wait. Do not jump into weight loss by whatever comes to your mind or whatever crosses your sight. Weight loss is good but unplanned weight loss or weight loss by wrong methods can damage health. Some popular methods only remove water from the body which gives a feeling of weight loss. But this has serious effects on health. Water loss from body is not weight loss. Another serious mistake is to try a drastic weight loss say for example 15 kg in 40 days. This has major side effects as body is not able handle such sudden change and body organs get affected resulting in many chronic diseases. Various nutritional deficiencies can also result if diet is severely restricted without giving consideration to necessary body requirements. This can also result in hormonal and psychological disbalance. Medically recommended weight loss is 0.5 kg – 1 kg per week or 2 – 4 kg a month. Your weight loss program must answer following questions :

Causes Of Obesity

• Genetic
• Over eating & unhealthy eating (eating more calories than consumed).
  Insufficient physical activity.
• Poor lifestyle
• Medical condition like hypothyroidism, hypogonadism, cushing syndrome etc
• Prosperity and modernization
• Psychological factors like bulimia, eating linked to emotions (stress, anxiety etc)
  

Assessment of Obesity
There are several methods to assess over weight and obesity states. Some are :

1. Height Weight Range : These are easy to use height weight charts for both males and females. It gives a range of recommended body weight. Some charts gives weight for short, medium and big statures.
2. Brocas Index : According to Brocas Index the ideal weight of a person is equal to height of the person in centimeters minus 100. For example if a person’s eight is 170 cm then the ideal weight would be 70 kg. Above that is overweight and above 20 % of ideal weight would be obese.
3. Body Mass Index : In BMI method weight in kg is divided by height ² (in meters)
   For example if a person is 92 kg in weight and has a height of 169 cm then the BMI would be 92 / 1.69 x 1.69 = 32.21
   BMI is graded as follows

   BMI is graded as follows Less than 25 - Not Obese 25 – 29.9 – Grade I Obesity 30 – 40 - Grade II Obesity Above 40 Grade III Obesity

4. Skin Fold Test : In this method subcutaneous fat (under the skin) is measured using skin fold calipers. The various sites of measurement are – at triceps, abdomen, above hip, subscapular upper back, bicep mid arm etc. For example anything above than 35 cm (females) and 40 cm (males) at waist is indicator of over weight. Body fat in %age can be calculated as follows :

   Skin fold in mm		% age of total body fat
   15 - 45 mm		8 – 22 %
   46 – 75 mm		23 – 30 %
   76 – 150 mm		31 – 40 %
   Normal body fat		upto 22 % males,upto 30 % females
   Grade I Obesity		upto 40 % fat
   Grade II Obesity		upto 45 % fat

   Estimation of weight Loss
   

1. Energy Balance : The basic rule of weight loss is to create a negative energy balance i.e. to take less calories than what will maintain weight and burn some. But this should not be done at the cost of depriving body its basic nutritional requirement.
2. Diet : Dieting is not starvation. Weight reducing diet must be carefully planned. A diet with 500 – 1000 calories less than daily calorie recommendation is ideal for safe weight loss. It must provide adequate proteins, vitamins and minerals. Lowest recommended calories for females is 1200 and for males 1500. A simple way to calculate calories is current weight x 24 – 500. If your current weight is 85 kg then a diet of 85 x 24 – 500 = 1540 calories would be good. Diet must contain less fat and more fibres. Food with high glycaemic index must be avoided. One must be consistent in eating habits avoiding erratic patterns. Avoid soft drinks, sweets, cakes, candies, fried food, cream, butter, alcohol, fruits like grapes, dried fruits, refined carbohydrates etc. Take whole grains, leafy vegetables, fruits like apples, salad etc.
3. Exercise : Exercises are must for safe and lasting weight loss. These help in burning calories and improve body metabolism. Low intensity sustained exercises like aerobic exercises are most suitable. To be more effective they must be done under trained professional. Brisk walking, jogging, swimming, cycling are also helpful.
4. Lifestyle : Develop a healthy lifestyle. Improve your awareness about weight metabolism, food, exercise etc. Having organized life, low stress and positive relationships all help in better weight management. (See Lifestyle Management)
5. Medical treatment : Diseases which causes obesity must be thoroughly investigated and treated. Conditions like hypothyroidism, hypogonadism, cushing syndrome causes obesity which will be difficult to manage unless these conditions are well treated. Sub clinical hypothyroidism is the cause of obesity in many people which remains undiagnosed.
6. Drugs and Surgery : There are some medical options available for weight management like drugs and surgery. But these must be reserved only for very specific conditions to be decided by appropriate doctors. They have their own complications and side effects so must not be used as ‘easy’ way of weight management.
7. Clinical Acupuncture : It is highly effective in weight management by balancing the energy system of the body, by removing the obesity disease producing blocks and by balancing the five basic elements. It also corrects hormonal imbalance.
8. Yoga : Yoga is very helpful for weight management. It improves metabolism, corrects hormonal & other medical conditions, removes water retention, keeps skin healthy and maintains vigor & vitality during and after weight loss. It improves will power and self esteem which helps in weight management.
9. Homeopathy : Constitutional homeopathy is useful aid in weight management. Homeopathy improves body functions & metabolism. It can help in normalizing appetite, removing food cravings, correcting psychological disorders like bulimia etc.
10. Counseling and Psychotherapy : One major barrier in weight management is negative attitude & behavior. Lifestyle, eating habits, exercise and many emotional conditions associated with obesity has attitude and behavior in background. Counseling & psychotherapy helps in assisting at psychological level and developing positive attitude & behavior. Psychological dependence on food, impulsive eating, lack of motivation, stress etc can be corrected by counseling and psychotherapy.
    

Precautions

• Weight Management requires consistent effort. Short term measures will only result in 'failure'.
• Most people succeed in weight loss but regain soon. Maintenance of what you have lost is more important for long term success.
• Do not expect or desire sudden or dramatic weight loss. This spoils health and cause many diseases.
• Beware of ‘easy’ methods of weight loss even if they claim to be herbal / harmless / natural / free of dieting & exercise. Beware of weight loss drugs unless specifically prescribed by appropriate doctor.
• Be careful to avoid nutritional deficiencies during weight loss.
  

• Avoid erratic eating pattern. Avoid untimely snacking.
• Do not skip meals specially breakfast.
• Watch out for hidden calories
• Do not keep high calorie and tempting food within easy range.
• Do not eat while watching TV.
• Do not gulp, eat slowly.
• Drink warm water.
• Do not sleep immediately after eating.
• Taste temptations can be satisfied through low calorie recipes, natural herbs & spices.

• Avoid inactive lifestyle
• Avoid sudden burst exercises.
• Exercise regularly.
  

• Keep medical conditions under regular observation

• Be consistent with your program.Set reasonable and realistic goals.
• Do not be too rigid, moderation is the key.
• Do not feel guilty over slips, make new commitment.
• Do not get careless after weight loss, continue maintenance program.
• Keep motivation high by reminding yourself of goals and benefits.
• Reward yourself on success but do not choose food as reward.
• Get support of family & friends and be social.
• Develop hobbies to release stress and make your life more satisfying.

• Develop a long term program. Develop healthy lifestyle, manage stress in life, if any.
• Avoid smoking.
• Get underlying sickness treated if any.
• Exercise to gain muscle mass.
• These must be short and intense muscle building exercises.
• Eat more calories than you are burning.
• Eat regularly. Eat healthy.
• Eat more of dairy products, eggs, dates, raisins, figs, banana, prunes, pulses, cereals, peas, dried fruits etc. Take fluids with calories like fruit juices, milk shakes etc.