it is for awareness about Role of exercise and life style modifications in Healthy Aging. This would prevent metabolic syndromes and Diabetes, Hypertension , CHD , Cancers and many problems of mid life beyond years.

1. Dr.Maninder Ahuja
PRESENT
DESIGNATIO
N:
• DIRECTOR AHUJA HOSPITAL AND INFERTILITY CENTRE
• FARIDABAD
• ON PANEL WITH AIMS, METRO AND SARVODAYA
HOSPITALS
PRESENT
AFFILIATION:
PRESIDENT INDIAN MENOPAUSE SOCIETY
DEPUTY SECRETARY GENERAL OF SOUTH ASIAN
FEDERATION OF MENOPAUSE SOCIETIES
MAJOR
ACHIEVEME
NTS:
(HONOURS)
(AWARDS)
(PUBLICATIO
NS)
EDITOR OF BOOK” PREMALIGNANT LESIONSOF CERVIX-
EARLY DIAGNOSIS AND MANAGEMENT”
AUTHOR OF BOOK “STEP BY STEP MANAGEMENTOF
MENOPAUSE
SEVERAL CHAPTERS IN TEXT BOOKS LIKE JEFFCOATE,
OPERATIVE OBSTETRICS AND GYNECOLOGY FOR
POST GRADUATES,PRINCIPLES AND PRACTICE OF
OBST, AND GYNECOLOGY, MANY DVDS ON “
PRESCRIPTION OF EXERCISE”
PHOTO

2. AGRAAGRA
AHEMDABADAHEMDABAD
BANGALOREBANGALORE
BHARUCHBHARUCH
CHANDIGARHCHANDIGARH
CUTTACKCUTTACK
CHENNAICHENNAI
DELHIDELHI
FARIDABADFARIDABAD
GURGAONGURGAON
HYDERABADHYDERABAD
INDOREINDORE
JALANDHARJALANDHAR
JAIPURJAIPUR
JAMMUJAMMU
KOLKATAKOLKATA
LUCKNOWLUCKNOW
MUMBAIMUMBAI
NAGPURNAGPUR
NAVI MUMBAINAVI MUMBAI
PUNEPUNE
RAIPURRAIPUR
RAJKOTRAJKOT
SURATSURAT
VARANASIVARANASIGWALIORGWALIOR
LUDHIANALUDHIANA
JODHPURJODHPUR
UDAIPURUDAIPUR
CALICUTCALICUT
PATIALAPATIALA
AJMERAJMER
ALLAHABADALLAHABAD
JABALPURJABALPUR
GUWAHATIGUWAHATI
BHOPALBHOPAL
BIKANERBIKANER
SHIMLASHIMLA
Current IMS ChaptersCurrent IMS Chapters
40 IMS Chapters all over India40 IMS Chapters all over India

3. How to slow down the hands of
time?
Control weight gain and exercise
Dr.Maninder Ahuja
Director Ahuja Hospital &Infertility
Centre setor 17 FBD

5. 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.
09/04/15Dr.Maninder ahuja 5

6. 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 80’s – a phenomenon and
we say never feel old and remain walking till
the final recall!
• From 30 yrs to 76 years
09/04/15Dr.Maninder ahuja 6

7. POPULATION PYRAMIDS

8. QUALITY OF LIFE IS IMPORTANT
• In these Golden Years
she wants to have her own
identity!
09/04/15Dr.Maninder ahuja 8
AAJ PHIR JEENE KI TAMMANNA
HAI ,
AAJ KUCH KARNE KA IRADA
HAI!!!!!!!

9. DOCTOR: A person who
kills your ills by pills,
and kills you by his
bills!
Change from pill doctors
Preventive health
Change from pill doctors
Preventive health
09/04/15 Dr.Maninder ahuja 9
WE ARE CHANGING CONCEPTS

10. 09/04/15Dr.Maninder ahuja 10
FIT AT FORTY
STRONG AT SIXTY
AND INDEPENDENT AT
EIGHTY !!

11. Physical Problems Slowing us
down
• Vaso motor symptoms
• Hot flushes
• Mood changes
• Sleep disorders
• Musculo Skeletal
• Sarcopenia
• Osteoporosis
• Joint aches and pains
• Osteoarthritis
• UGS- itching vagina,
dysparunia
Metabolic syndrome
• Cardiac problems
• Hypertension
• Obesity
• Cardiorespiratory
Long term
• Longevity
• Cancers
• Alzheimer

12. 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.
•

13. CHANGING TIMES

14. Which one is Quality life?
09/04/15Dr.Maninder ahuja 14

15. 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

16. 09/04/15 Dr.Maninder ahuja 16
A small truth to make life 100%
and enjoyable!
A SMALLA SMALL
TRUTH TOTRUTH TO
MAKE LIFE 100%MAKE LIFE 100%
What makes life
100%

17. 09/04/15 Dr.Maninder ahuja 17

18. 09/04/15 Dr.Maninder ahuja 18
Hard WorkHard Work
H+A+R+D+W+O+R+K
8+1+18+4+23+15+18+11 = 98%
KnowledgeKnowledge
K+N+O+W+L+E+D+G+E
11+14+15+23+12+5+4+7+5 = 96%

19. 09/04/15 Dr.Maninder ahuja 19
LoveLove
L+O+V+E
12+15+22+5 = 54%
LuckLuck
L+U+C+K
12+21+3+11 = 47%
( don't most of us think this is the most important ??? )

20. 09/04/15 Dr.Maninder ahuja 20
Then what makes 100% ?
Is it MoneyMoney ? ... NO ! ! !
M+O+N+E+Y
13+15+14+5+25 = 72%
LeadershipLeadership ? ... NO ! ! !
L+E+A+D+E+R+S+H+I+P
12+5+1+4+5+18+19+9+16 = 89%

21. 09/04/15 Dr.Maninder ahuja 21
ATTITUDEATTITUDE
A+T+T+I+T+U+D+EA+T+T+I+T+U+D+E
1+20+20+9+20+21+4+5 =1+20+20+9+20+21+4+5 = 100%100%
It is OUR ATTITUDE towards
Life and Work that makes OUR
Life 100% ! ! !

22. Keep laughing !

23. Throw out all non essential
Numbers
• That includes Age
• What number you should be careful about is
your weight and WHR

24. So to slow down
hands of time
We have to
change our
attitude !
B +

25. 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 !

26. The rise of non communicable diseases in India

27. 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

28. Causes of obesity
• Can be continous from
adolescents
• Around perimenopause

29. What worries you most ?
• External appearance ?
• Over all fitness?
• Both ?

30. SYNCHRONIZATION OF FACE AND
BODY

31. External appearance
• Can be arranged by spending money but for a limited time
only.
• Cosmetic surgeries
• Laser
• Botox
• Collagen fillers basket full !

32. 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.
5-05-2007 Dr.maninder ahuja

33. 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 syndrome
04/09/15 33drmaninder ahuja NARCHI

34. SARCOPENIA-what you can’t see
GOOD LEAN MASS SARCOPENIA
5-05-2007 Dr.maninder ahuja

35. Leisure time increases

36. Ideal weight and WHR
• For asians
For others
• BMI of 18-23normal.
(20-25 )
• BMI of 23-28 is
overweight (25-
30)
• BMI of over 28 is
obesity (>30)
• BMI of over 35 is
morbid obesity
• BMI is Wt.in Kg /ht in
sqM5-05-2007 Dr.maninder ahuja

37. 04/09/15 drmaninder ahuja NARCHI 37

38. BMI CALCULATING CHARTS

39. WEIGHT CONTROL BY CALORIE
RESTRICTION
• Caloric restriction, the
centerpiece of weight-loss
efforts for most women,
decreased BMR and loss of
fat free mass.
• Because the resting
metabolic rate accounts for
nearly two thirds of total
caloric expenditure and
muscle mass accounts for
20%of REE
5-05-2007 Dr.maninder ahuja
NO!!!

40. Weight loss
• Is it a losing
battle?
09/04/15Dr.Maninder ahuja 40

41. MOTIVATION!
09/04/15Dr.Maninder ahuja 41

42. All calories are not same
• Extreme restriction of fat or carbs can have bad effects.
• The best long-term approach will be to avoid restriction of
any major nutrient—either fat or carbohydrate—and instead
focus on the quality of nutrients. This is not to say that the
number of calories isn't important, but it's now saying we
should also pay attention to the quality of those calories.
• So the argument that the food industry likes to make—that all
foods can be part of a healthful diet as long as you watch
calories—is really misleading at best.
•

43. 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.

44. 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,(

45. Strongest support for concept that not all calories are
the same
• Low-carb diet : increases in CRP, a measure of chronic
inflammation, 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 energy
expenditure—"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

46. Diets

47. SUGARS??????

48. Smoking is bad !!

49. Dynamic Duo !

50. Role of Vit D
• Serum 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 levels
• Vitamin 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 risk
09/04/15
Dr.ManinderAhuja chairperson geriatric
gynecology committe FOGSI
51

51. Vit D Def & Risk Of Falls
09/04/15
Dr.ManinderAhuja chairperson geriatric
gynecology committe FOGSI
52

52. 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

53. The ABC of Physical Activity for Health: a consensus statement from the British
Association of Sport and Exercise Sciences.

54. 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

55. 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

56. 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

58. Weight gain in midlife
less if started early
• Our body’s 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.

59. BANKING OF GOOD HEALTH HAS TO START FROM ADOLELSCENCE
09/04/15 dr.maninder ahuja 61

60. It is for you to decide now if you
want One with stick, one with wiper!
5-05-2007 Dr.maninder ahuja

61. Structured daily routine activities
04/09/15 drmaninder ahuja NARCHI 63

62. 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 45-
minute fat-burning exercise period to burn
1lb of fat, which is 3,500kcal.
09/04/15 Dr.Maninder ahuja 64

63. Despite all these if you have

64. Weight lifting is good !

65. 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.
09/04/15 Dr.Maninder ahuja 67

66. 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 meditation
09/04/15 Dr.Maninder ahuja 68

67. Stretching exercises

68. Exercises
Stretching exercises
Resistance and weight bearing

69. Strength training in
osteoarthritis
• AFTER 12 WEEK ST TRAINING PROGRAMME
• Balance improved55 %
• Muscle strength increased 14 %
• Flexibility improved 17%
• Self-reported pain decreased 30%
• Tibial cartilage volume increased.
• © 2007 Current Medicine Group Ltd, a part of Springer Science+Business
Media
09/04/15 dr.maninder ahuja 71

70. You need stamina for walking!
09/04/15 Dr.Maninder ahuja 72

71. 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 test
09/04/15 dr.maninder ahuja 73

72. MENOPAUSE AND EXERCISE
• Menopausal status does not appear to lower a woman's ability to favorably alter
her body composition and cardiorespiratory endurance through aerobic
conditioning
• Exercise is particularly helpful for middle-aged women who want to control their
weight because it reverses the diet-induced reduction in metabolic rate and also
increases fat-free mass. In fact, physical activity of sufficient magnitude can
largely offset age-related changes in body composition.
• A cross-sectional study of female athletes and sedentary women, aged 18 to 69,
found no difference in body fat percentage and fat-free mass between the
youngest and oldest athletes.
• In addition, the resting metabolic rate of the older exercisers was closer to that
of the young athletes than to that of sedentary, age-matched women.
• (11) Cowan MM, Gregory LW: Responses of pre-and post-menopausal females to aerobic conditioning. Med Sci Sports Exerc 17(1):138-143, 1985.
• Ryan AS, Nicklas BJ, Elahi D: A cross-sectional study on body composition and energy expenditure in women athletes during aging. Am J Physiol
1996;271(5):E916-E921
• Fiatarone MA, Effects on skeletal muscle. JAMA. 1990; 263:3029-34

73. 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

74. DANCING IS BEST AEROBIC EXERCISE

75. 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

76. Integrated into your life style!

78. AS A LAST RESORT !!

79. 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!
09/04/15 Dr.Maninder ahuja 81

80. Be together and keep dancing!

81. Don,t be left behind!
Turn back the clock !!!!!
नीद भी खुली न थी िक हाय धूप ढल गई,
पाँव जब तलक उठे िक िज़नदगी िफसलगई,
और हम झुके झुके ,
मोड़ पर रके रके
उम के चढ़ाव का उतार देखते रहे।
कारवाँ गुज़र गया, गुबार देखते रहे।
09/04/15 Dr.Maninder ahuja 84

82. 09/04/15 dr.maninder ahuja 85