Pain management Simple stretches for the neck, shoulders and back I have taken up a new job that requires me to sit in front of the computer for long hours. I am 50 years old and have been undergoing therapy for back pain. But in this new job, I have been suffering from neck and shoulder pain as well. Please suggest a compatible exercise plan. Check if your work station is ergonomically sound. If your desk ergonomics is not favourable, your back and neck problems will persist. Along with good ergonomics, supervised stretching exercises and weight training will help you as well. Here are a few stretching and back strengthening exercises: Stretching exercises Stretch daily but don't push it hard; movements should be smooth and slow. Stretching can even be carried out for 5 repetitions with a 10-second hold. Neck retraction stretch: Stand or sit for this stretch. Pull your head back as far as possible and down slightly. Hold the stretch. This targets your sternocleidomastoid (in the anterior portion of the neck) and splenius muscle (a broad muscle in the back of the neck). Neck rotation: Stand or sit for this stretch. Turn head over shoulder to one side. Hold stretch. Repeat to other side. Head can be pulled towards the back. This targets your sternocleidomastoid and splenius muscle. Neck side stretch: Bow head forward with jaw shut. Depress chin into top of the sternum. Slightly turn your head to one side and hold the stretch. Repeat on the other side. This targets your splenius muscle. Deltoid stretch: Position your right arm across the chest. Place your left hand on the elbow and push the elbow towards the chest. Hold for some time before repeating with the opposite arm. Positioning arm on the upper chest stretches the rear deltoid. Back deltoid stretch: Face a stationary bar and grasp it with your right hand at chin level. Rotate your body to the right so the upper arm is positioned across the chest. Hold and repeat with the other arm. Triceps stretch: Put an arm overhead, with the forearm as close as possible to the upper arm. Grasp your elbow overhead with the other hand. Pull the elbow back and towards the head. Hold and repeat with the other arm. Biceps stretch: Clasp your hands behind the back with palms together. Straighten your arms and rotate (inside down) with palms turned downwards. Raise arms away from body and hold the stretch. Cat stretch: Kneel on a mat and place hands shoulder-width apart. Flex spine by hunching back up. Extend spine by arching back. Gluteus stretch: Lie supine on a mat with knees bent. Cross right leg over the left thigh. Hold the left leg from behind the thigh with both hands. Pull the leg towards your torso. Hold this stretch for some time and repeat with the other leg. Standing glutes stretch: Stand facing an elevated platform. Place the outside of your foot on the platform with knee bent out to the side. Lean by lowering the torso towards the thighs. Hold the stretch. Repeat with the second leg. Hands can be placed on elevated platform to maintain balance. Spine should be straight, though the pelvis may be tilted forward to intensify the stretch. Quadriceps stretch: Lie prone on a mat with your right arm extended. Hold your left ankle or forefoot from behind with your left arm. Pull your left foot towards your left hip. Hold the stretch for some time and repeat with the right leg. A thickly folded towel can be placed under the upper hip if lumbar spine hyperextension is otherwise uncomfortable. Hamstring stretch: Sit on a mat with legs straight. Reach forward and bring upper body toward the legs. Hold the stretch. Spine should be straight, while pelvis may be tilted forward to intensify the stretch. Back strengthening exercises Repetitions: 5; Sets: 2; Hold for 10 seconds Glute bridges: Glute bridges also work your rectus abdominus, placing special emphasis on the lower muscle fibres. Assume the crunch position with your feet flat on the floor. Squeeze your abs to press your lower back into the floor as if you were doing a pelvic tilt. Maintain this contraction as you squeeze your glutes to lift your hips off the floor until your body is in a straight line from shoulders to knees. Lower slowly back to the floor. Pelvic tilts: Pelvic tilts are a gentle version of crunches; like crunches, tilts work the rectus abdominus. For pelvic tilts, assume a crunch position with your feet flat on the floor. Squeeze your abs to flatten your lower back into the floor. Hold briefly, and then relax so that your lower back lifts slightly off the floor, back into its natural, neutral curve. Planks: Position yourself facedown on the floor, supporting your weight on your forearms and toes. Squeeze your abs to hold your body straight from head to feet; don't let your hips sag down or lift up. Alternating leg and arm raises: This strengthens the back, lower back and glutes. Lie on your stomach, arms reached out past your head with palms and forehead on floor. Tighten abs. Lift one arm (as you raise your head and shoulders) and the opposite leg at the same time, stretching them away from each other. Hold for five seconds and then switch sides. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net. If you have a question for him write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine August 2012

Face lift Anytime exercises to tone up your face I am a retired woman with a thyroid problem. Though I exercise regularly to stay fit, I feel I am putting on a lot of weight on my face. Are there any exercises to keep facial muscles active and toned? Exercises are meant to tone up the muscles, flex them, relax the body and increase blood circulation. Similarly, facial exercises help tone up facial muscles and keep them relaxed. If done properly for a few minutes every day, facial exercises can help reduce stiffness and dullness from the face and decrease wrinkles. Other benefits: better elasticity of the skin and preventing early ageing (in fact, better than many expensive cosmetics). You can do these exercises any time during the day; unlike the general workout, you don't have to wait for your stomach to be empty or partially filled. You can also do them while taking a bath, reading the newspaper, driving or watching television. Jaw line exercise Place a hand on your neck, right under the jaw line. Now, slightly open the mouth, keeping it open throughout the duration of this exercise. Your hand will be able to feel the muscles working. Then, pull down the corners of your mouth, remembering to keep the mouth about halfway open. The move is subtle, but you can feel the muscles just under the jaw working. This will firm the jaw line and reduce the chance of sagging skin and jowls, or tone the area where you have already noticed sagging. Jowl exercise Sit or stand comfortably and look slightly upward towards the ceiling. Keep your lips together but don't press them closed. While keeping the head tilted upward, pretend you're chewing gum. This exercise, which was developed by Jack LaLanne, can be done while sitting at a desk. Maintain this position while you pretend to chew about 20 times. Do this several times during the day and you will notice the muscles just under the chin (sternohyoid) and the jaw muscles (masseter) toning and firming. This exercise is good for reducing unsightly looking jowls and will help reduce the problem of double chin. Mouth exercise The area around the mouth loses tone, causing sagging around the jowls. The corners of the mouth over time tend to droop downwards. The California Dental Specialty Group has created a facial exercise to help reinforce facial movement and muscle tone. This is a smiling exercise. It will firm and tone the area around the mouth and give you greater control over your smile. This exercise should be done in front of a mirror. Start by relaxing the facial muscles. Slowly smile by stretching the corners of the mouth laterally. Keep the lips together and hold for 10 seconds. Next, smile wider exposing the edges of the teeth, hold for 10 seconds. Smile wider, increasing muscle tension and exposing the upper teeth. Make sure to keep the eye area relaxed. Hold for 10 seconds. Finally, smile as wide as possible using lateral tension and exposing all the upper teeth without showing the gums. You should feel a slight burning in the cheek muscles at this point. Hold for 10 seconds and relax. The second half of this exercise uses the index fingers for gentle resistance. Smile wide and place the index fingers at the corners of the mouth. Start relaxing your smile, but keep resistance on the corners of the mouth and hold for 10 seconds. Try to close your mouth while keeping resistance, hold for 10 seconds and relax. Repeat this exercise five times. Double chin lift A double chin is one of the biggest signs of ageing. You can reduce the look of one or make it disappear altogether by performing a simple exercise. Lie on your back, then lift your head off the floor so your chin rests on your chest. Then, bring your head back to the floor. Repeat this several times, but don't overdo it. If you feel pain or too much tension in your neck, stop. Cheek and chin tone-up You can tighten your facial and neck skin by performing a smiling exercise in front of the mirror. Place your bottom lip firmly over your top lip and try to smile as wide as you can. Then, lift your head up so your chin is pointed upward, and hold. After staying in this position for about 10 seconds, relax your face. Repeat five times. You can do this exercise in the morning and at night for a toned neck and cheek muscles. Firmer cheeks Perform this exercise while sitting in a chair with your head back and your three main fingers gently on the centre of your cheeks. Raise your cheeks by smiling as hard as you can, while simultaneously applying gentle resistance in a downward motion with your fingers going against the smile. Relax and repeat 10 times. Eye area The delicate skin around the eyes can start to lose tone, causing drooping eyelids and sagging around the corners. To tighten the area, try this yoga exercise from Annelise Hagen, author of The Yoga Face, who teaches facial yoga in New York City. Sit with your back straight and smile. Place your index fingers on the corners of the eyes where crow's feet form. Next, maintaining resistance with your fingers, pulse your lower lids against the resistance. Do this by contracting the muscle in the lower lid, trying to close the eyes. Move the lower lid up as far as possible without actually closing the eyes. Relax and repeat. Do not move any other facial muscle. Do three sets of 20 repetitions. Crow's feet lift You can avoid crow's feet by toning up the skin around the eyes. To do this, close your eyes and use your thumbs to move along the skin from the corner of the eye to the temple. Repeat several times. This will firm up the skin over time and prevent that familiar nest of wrinkles that sprout out from the eyes as you get older. Eyelid lift The eyelids are the first to show age on the face. However, you can keep them from sagging by simply using your index finger to press on the skin just below your eyebrow. While holding this skin, push upward and close your eye to stretch the eyelids. By doing this several times each day, you firm up the skin in the area and reduce sagging.

Lower-eyelid strengthener The orbicularis oculi muscle is firmed up with this exercise. This area is just under the eyes, in the area that forms the hollows. Place your index fingers at the outer corners of your eyes and your middle fingers at the inner corners, and apply light pressure. Roll your eyes up, and squint with the lower eyes while lightly holding the corners of your eyes. Tighten and release for 10 repetitions. On the 10th tightening, hold for 40 seconds. This exercise is from Carole Maggio, the author of Facercise. Temple dancer eyes This yoga exercise works the oribicularis oculi, the muscles that circle the eyes. It helps prevent sagging skin and crow's feet and is a favourite eye muscle exercise of fitness expert Jack LaLanne. Sit with your back straight and your head facing forward. Look to your right, then ahead, then look left and back ahead. Do not move your head, and keep your face relaxed. Next, reverse the direction. Repeat about four times, then close your eyes and look down. Brow-lifter This exercise firms the brows and lifts the upper eyelids. It is ideal for eyelids that are starting to droop. Sit facing forward, with your spine erect. Widen your eyes as far as you can. Make sure not to wrinkle your brow, and focus on a point in the distance. Hold for five to 10 seconds. Repeat four to five times. You should feel a flush in your forehead from the circulation. Face-lift exercise The face-lift exercise is recommended by the California Dental Specialty Group to keep facial muscles toned. One reason muscles sag is because of lack of use. This exercise works the quadratus labli (a sheet of muscle from the side of the nose to the upper lip), strengthening and firming them. Open your mouth slightly, flare your nostrils, and wrinkle your nose while drawing your upper lip as high as you can. Relax. Next, place your index fingers on the top part of your cheeks, just under your eyes. Open your mouth slightly, curl your upper lip, hold for 10 seconds, then relax. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for him write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine July 2012

Leg-up Stronger muscles for the long run I am a skinny 75 year-old. I have noticed that my legs start trembling when I walk fast or try to run. I am scared of falling and suffering a fracture. Please suggest some leg and calf-strengthening exercises that I can do at home. Leg exercises help maintain balance and stability and, therefore, prevent falls. Begin each leg exercise with eight repetitions and increase gradually. To add to the effectiveness, use leg weights or durable resistance exercise bands (both available at sports equipment stores). WARNING: Always consult your doctor before beginning any exercise programme. Stop exercising immediately if you feel any symptoms such as shortness of breath or dizziness. Your legs carry you places, and provide you with a way to get around. Many people do not know the importance of legs until something unexpected restricts them. It is important to build limb strength with the help of leg strengthening exercises. In fact, leg muscles are the fastest in your body to respond to training. It's not only cardio that defines and shapes your legs—in combination, one needs to do exercises specifically designed for legs. Here are a few exercises that can be done at home: Lunges Lunges are best for exercising leg muscles with one simple move. Stand with your feet shoulder-width apart. Take one giant step forward with your right foot. Place your hands on the hips for balance. Now, lower your body straight down until your back leg forms a right angle at the knee. Raise yourself up slowly using your leg muscles and repeat the movement for three sets of 30 repetitions for each leg. You can start with fewer repetitions—in fact, as many as you can manage and increase only gradually. If you have knee pain, take a smaller step forward and drop down as far as comfortable. While lunges are the best leg exercises, they can be challenging for people with bad knees. Squats Squats work your glutes, quads, hamstrings and calves, all at once. Stand with your feet hip-width apart, toes facing straight ahead or angled slightly outward. Slowly bend the knees and lower hips towards the floor, keeping your torso straight and abs pulled in tight. Keep your knees behind your toes; make sure everything is pointing in the same direction. Do not go lower than 90°. Do these thrice a week (alternate days) for 12-16 reps or less to begin with. Quadriceps extension This exercise works the top-front of your thigh. Sit up straight in a chair with knees bent and both feet flat on the floor. Place weights on your ankles or wrap exercise bands around both ankles. Tighten your abdominal muscles. Extend the right leg until the knee is straight but not locked. Then, lower the right foot slowly down. Perform at least one set for each leg. Knee flex Stand up straight and hold on to a table or sturdy chair for balance. Keeping the upper part of your leg straight, bend one knee, raising your foot behind you. Lower the foot, and then repeat with the other leg. Keep your back straight and don't lean on the chair. Outer thigh exercise This exercise works the top outside of the thigh. Sit up straight and tighten your abdominal muscles. You can wear ankle weights or wrap the exercise band around both knees. Keep the left knee bent and the left foot flat on the floor. Extend your right leg straight but do not lock the knee. Bring your right leg out to the side and then back to the centre. Keep the leg at hip height the entire duration. This is a sideways movement. Avoid swinging the hips or leg. Perform at least one set for each leg. Inner thigh lift This exercise works the top inner part of your thigh. Sit up straight and tighten your abdominal muscles. You can wear ankle weights or wrap the exercise band around both ankles. Keep the left knee bent and the left foot flat on the floor. Let your right knee fall out to the side, so you are turning your right leg out. Lift the right heel straight up as high as you can without rounding through the back. Keep the knee out to the side and the inside of your foot lifting straight up. Slowly lower it. Perform at least one set for each leg. Hamstring curl This exercise works the top back of your thigh. Sit up straight in a chair with knees bent and both feet flat on the floor. Place weights on your ankles or wrap the exercise band around both ankles. Tighten your abdominal muscles. Keeping the left foot still, pull the right heel underneath the chair. Then bring it back, so the knee comes to a 90° angle; then lightly place your right heel on the floor. Perform at least one set for each leg. Heel raises Heel raises are one of the best leg exercises because they can be done anywhere without attracting odd glances from strangers. This exercise targets calf muscles, which are a problem area for many people. Calves respond to strengthening very quickly and get in shape very quickly. Therefore this is the best leg exercise for people who want fast results. Stand with your feet wider than shoulder-width. Place your hands on hips for balance. Raise your body onto your tiptoes and hold for a few seconds. Gradually come back to the original position. Repeat this exercise for three sets of 40 heel raises. When you are ready for a bigger challenge, stand on the step of a staircase or sturdy elevated surface and allow your heels to hang off the edge. Raise and lower your body slowly for three sets of 25 repetitions. This works the calves immediately. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for him write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine June 2012

Even footing Get your balance together I am 67 and have been diagnosed with balance disorder. Doctors have advised regular exercise to prevent the progression of the problem. However, I find it difficult as I am afraid of falling. Is there anything I can do at home to make me more confident of not falling and injuring myself? Balance exercises help you develop strong leg muscles and prevent falls. To begin with, follow these simple safety guidelines: Balance exercises are intended for normal imbalance and unsteadiness owing to inactivity and disuse. Make sure you check with your doctor if you suspect a more serious balance problem involving vertigo, ear infection, Meniere's disease, chronic dizziness or drug interactions. If you are exercising for poor balance and have a frail physique, make sure you are closely supervised at all times. Progress to the next exercise when the preceding one can be done safely or if you have enough assistance. Be aware of your posture; try to maintain your weight over your ankles. Avoid fast movements including quick turns or changes in position. Always get up slowly when rising from a chair. Don't close your eyes when exercising or standing near your chair. If you are taking medication, ask your doctor if there are any side-effects that may cause light-headedness or decreased balance. Balancing exercises are challenging If you are uncomfortable about these exercises or are unsure of your ability to complete them, don't try them alone. Start slowly with the first exercise; it will take you time to get used to the new experience of stressing your balance system. It is not a race to the finish. You may be comfortable only performing the first few balance exercises and not comfortable with the moving and walking exercises. That is okay. Never do something you are nervous about. It's better to have a helpful, stable person around to make you more confident and secure. Side leg raise Stand behind a table or chair, with feet as wide apart as shoulders. Hold on to the table or chair for balance. Lift your right leg to the side about 12 inches (or as far as is comfortable) while keeping your back and both legs straight. Hold for several seconds. Repeat with your left leg and continue until you have done 10 reps (or repetitions) with each leg. Hip flexion Stand behind a chair or table and hold on for balance. Bend one knee slowly toward your chest. Hold for a second and then lower slowly. Repeat with the other leg and continue until you have done 12 lifts with each leg. Standing on one foot Stand behind a chair without wheels. Place one or both hands on the chair for support, if you need it. Shift all your weight to the right leg and lift the left foot off the ground. Hold this position for 15-30 seconds; switch and perform the exercise using the left leg and right foot. Try this exercise with open and closed eyes. Work to increase the time you are able to stand on one leg with and without support. Heel toe walking Stand with your feet hip-distance apart and toes pointed forward. Step one foot forward in front of the other, leading with the heel. Follow through by rolling on to the ball of your foot. Perform the same movement using the other leg. Complete this movement, walking across the room for five to six complete steps. Side steps over an object Place a large rolled-up towel on the floor. Stand with your feet parallel to the towel and hip-distance apart. Step sideways over the towel with slow and controlled movements, placing your foot on the ground and on the opposite side of the towel. Step back over the towel, placing the feet side by side. Complete this stepping over and back movement 10-12 times; then switch and perform the movement using the opposite foot. Stability ball sit Place a 55-75 cm stability ball up against a wall for support and stability. Sit on it. With your feet hip-distance apart, place your hands on both sides of the ball. Lift both arms up to shoulder height and hold them out to the side for 15-30 seconds before placing them back on the ball. Repeat this exercise two to three times. If you find this exercise easy, attempt it with eyes closed, or with one foot off the floor. Heel lifts Strengthen the muscles of the feet, the plantar fascia, which run the length of the soles of each foot and provide a springboard of muscle to support your ankle, knee and hip joints. Stand barefoot on a slip-proof surface and place one hand on the wall if your balance is tenuous. With your feet hip-wide, lift the heels and come onto the balls of the feet, imagining you are grasping a bar below. Pause for a moment before lowering your heels. Repeat 10-15 more times. If it is too difficult raising both heels, alternate one foot with the other. Modified squats Build your thigh muscles, quadriceps on the front and hamstrings at the back, along with the gluteus maximus on the back of the hips, with modified squats. To prevent falling, use a stable table set against a wall that will not move or slide or use a kitchen countertop that doesn't move. Place your palms flat on the table or countertop so your arms are extended straight. Lower your hips as if you are sitting in an invisible chair, until your hips are almost at the level of your bent knees. Pause before standing again. Repeat 10-15 times. These muscles enable you to squat, sit on a chair, get up, and walk the stairs. Standing single leg lift Exercise the muscles at the sides of the hips, the gluteus medius, which help contribute to balance. A classic physical therapy exercise is to stand with feet hip-distance apart, placing the right hand on a table or on a wall for balance, lifting the left foot and extending the leg to the side about 30° for 10-30 seconds before lowering the foot. Repeat on the right side. Do once more on each side. This strengthens the hips if you tend to sway to one side. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Visit www.talwalkars.net If you have a question for him write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine May 2012

Boost your body Simple exercises to improve stamina I am 62 years old and want to take up either swimming or dancing. However, owing to an inactive life thus far, I don't feel physically fit. How can I build my stamina? I am slightly overweight as well. Stamina is the resilient power of the body to sustain composure against abrasion from the physical world—work, sports or some other physical activity. Generally speaking, stamina varies from person to person. It also depends on the state of the body, i.e. age, gender and conditions like injuries. However, the fact remains that it can be increased by constant and deliberate efforts. Lack of stamina causes problems like fatigue and lethargy owing to which we feel boredom, our efficiency decreases and we become prone to diseases. We can safely conclude that the very essence of a vital and prolonged life is the improved level of stamina. Believe it or not, there are exercises that can help you increase stamina; below, you will find a few that you can do every day. Interval training Interval training involves short bursts of high-intensity activity, followed by short cool-down periods of low-intensity training. For example, a minute of high knees would be followed by 30 seconds of step touch. Or running at 8 mph for three minutes would be followed by a minute of jogging at 4 mph, for a short period of time. Quick bursts of energy followed by short breaks to catch your breath are a great way to improve your stamina. Bicycling If you have access to a stationary bicycle or even a 'real' fitness bike, put it to better use by increasing your mileage, not the intensity. To build stamina you want to ride for distance first, and then for intensity. Swimming Swimming is great as you have to learn to incorporate your breath into every stroke. It also places no pressure on the joints, so you can use it to increase your cardio endurance without worrying about having bad knees in the long run. Skipping Start small. Skip for a few minutes daily, as long as you feel comfortable. Each week, try to increase the duration a little. This can have a good effect on increasing your stamina. Running on the spot Run on the spot for a set period of time, like two minutes to start with. Later, as days pass by, you can increase it to maybe five minutes. Running briskly This is another common method used to improve stamina. You can jog in the morning for a short distance every day; after a few days, increase your speed to cover the same distance; and after a few more days, you can further increase the speed as well as the distance. This improves stamina. Racquetball Racquetball is fast paced and fun! If you're diving and slamming a ball against a wall, time simply flies by. And that's great, because you won't notice yourself working up a sweat that will eventually help increase your stamina. Step climbing Whether you are at work, in your apartment complex, or training in a football stadium, climbing steps is a sure way to beef up your stamina. Just a few steps will get your heart pumping and eventually you will be able to measure your progress by your ability to conquer a flight of steps without gasping for air. Team sports Whether playing soccer or tossing around a Frisbee, you will improve your stamina; fun activities with friends help you do this without noticing how much you worked out and for how long. Yoga This may seem counterintuitive as a stamina improver, but yoga teaches you to regulate your breathing. When it comes to exercising, knowing how to breathe in and out correctly is the key. In turn, breathing correctly directly corresponds to your performance, which is directly tied to your stamina. Lifting weights Most people think of aerobic exercise when they are trying to increase stamina. However, the truth is that real fitness magic happens only when you simultaneously improve your muscular and cardiovascular systems. If you want to drastically increase your stamina, use weight machines, free weights, fitness bands and your own body weight (my favourite). Exercise three times a week; this should help you lose weight. Don't forget to get a good night's sleep. This is nearly as important as working out when it comes to staying fit and losing weight. What you eat and how many times Eating fruits and leafy green vegetables can help you lose weight. Eat lean meat and fish. Eat small portions six times a day (and not the conventional three) to generate more metabolic action. Tips Be aware of what you put in your mouth. Don't eat while you are watching television. Take the stairs instead of the elevator. Walk instead of driving. Buy yourself some small hand weights and 'pump iron' while you are watching television. Stop eating when you are full. Deprivation (starvation) is not going to work, so don't do it. Avoid the foods that you know make you feel bloated, fat and uncomfortable. Walk your dog. Roll around on the floor with your grandchild and have some fun. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for him write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine April 2012

Trim your tummy Work on your lower abs with these easy exercises I am a 58 year-old woman leading a busy and active life. I go to the gym occasionally and walk regularly. I feel I am fit, but my lower abdomen seems to sag. Please suggest some easy exercises to help make my muscles more taut. To reduce the loosening of skin around the lower abdomen, you need to follow the following steps religiously: Regular cardio exercises Strength training for the entire body (treating the abs just like any other muscle in the body) A healthy, low-calorie diet You must get all three of these (especially your diet) right on a consistent basis. Here are some easy exercises for the abs Crunches: Lie flat on your back on the floor. Take a deep breath, suck in your stomach, keep your eyes focused on the ceiling, and raise your upper body off the ground until it is at a 45° angle with the floor. Don't pull on your neck, as this can lead to neck pain and, in extreme cases, migraine. If you suffer from any back problems, consult your physician and trainer at the gym. Hold the contraction for two to three seconds and slowly return to the starting position. Perform three sets of 10-15 repetitions (reps). Standing side bends: Stand up straight and suck in your stomach. Keeping your legs straight and your arms at your sides, lean from left to right. Make sure you don't rotate the hips; rather, keep your upper body in a forward-facing position and simply tilt your body left and right. This easy exercise primarily works the obliques; it also engages the entire abdominal wall and some of the lower back muscles. Perform three sets of 10-15 reps, or as much as you can manage as a beginner. This could be increased to 10-15 reps for three sets over a few weeks. Torso twists: The torso twist is one of my favourite routines for tightening up the midsection and it is among the best, yet easiest, abdominal exercises. Stand up straight, suck in your stomach and rotate your upper body from left to right while keeping your legs straight. As you turn, you will engage both the internal and external obliques, which are very important core muscles. The contraction pro-duced in this exercise will hit the obliques from a different plane of motion than the side bends. Perform three sets of 10-15 reps. Double crunches: Whenever you do a crunch, you work the entire abdominal area, but there are ways to add a little more emphasis to certain sections of the abdominals. The double crunch combines the crunch and another exercise called the knee raise, which will place more emphasis on the lower abdominal region. Lie flat on your back on the floor with your legs in the air and your knees bent at a 90° angle so your calves are parallel with the floor. Take a deep breath, suck in your stomach, keep your eyes focused on the ceiling, and raise your upper body off the ground until it is at a 45° angle with the floor. Once again, make sure not to pull your neck. Hold the contraction for two to three seconds and slowly return to the starting position. Perform three sets of 10-15 reps. Plank hover: Start the exercise lying face down in a push-up position, or plank, but resting on your forearms and elbows. Stay on your toes, and slowly flex your feet. Push back on your arms, keeping your hips in line with your shoulders and feet. Slowly push forward, pointing toes, maintaining the long line with hips, shoulders and feet. Repeat front and back 15 times. Oblique twist: Sit on the floor with knees bent, and lean back slightly, holding a weight or a heavy book. Twist your upper body, and lightly touch the object to the ground. Then, twist to the other side to complete one rep. To make it harder, lift your feet off the ground, keeping abs tight to protect your lower back. Bicycle exercise for abs: Lie on the floor with your fingers behind your head. Bend your knees and raise your legs above your hips, calves parallel to the floor. Bring one elbow to the opposite knee while pressing the other leg away from your body at 45°. Change sides. Beginner tip: Start with both feet on the floor. As you bring one elbow across, bring the opposite knee up to meet it, then put it back down and repeat on the other side. Side planks: Lie on one side with your knees bent and your forearm on the floor. Keep your elbow in line with your shoulder. Press your weight into your elbow and lift your hips and upper body off the floor so you make a straight line from knee to head. Hold for as long as you can—try for 10-20 seconds at first; build up to a minute. Switch sides. As you get stronger, try straightening the arm, straightening the legs, and then straightening both. Rockette moves: Start by lying on your back with your hands laced behind your head and your legs straight up, perpendicular to your waist. Pull your abs down toward the floor and lift your head and shoulders up towards the ceiling. Then, lower one leg down and bring your opposite shoulder towards that thigh. Alternate and slowly build up to 20-40 reps. Tailbone lifts: To work your lower abdominal muscles, lie on your back, arms stretched straight over your head and legs fully extended and crossed in the air. Exhale and lift your tailbone, then slowly lower as you inhale (don't just drop—resist on the way down). Repeat a few times and build up to 30 times. Inverted crunches: To work your lower back, lie on your stomach, arms in front of you as if flying. Exhale and lift just your right arm and left leg as high as you can. Inhale and lower. Then switch sides, lifting your left arm and right leg. Try doing 20 lifts on each side. Finally, lift both arms and legs 20 times. Rest and recovery (R&R): Abdominal muscles need R&R just like the rest of your body. It's only during rest that your muscles build. Work on posture: Balance out your exercises and posture by working on your back as well as abs. Lie face down on the floor, arms extended above your head. Use your back to lift your arms and legs a few inches off the floor. Release and repeat. It is very important that you do not overdo these exercises; always start with a lower number of reps and build your way up. Also, if you start to feel any discomfort or pain, stop the exercise immediately or you will end up hurting yourself. Always remember to breathe as you do these exercises. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website:www.talwalkars.net If you have a question for him write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine March 2012

Take the plunge Water can make your legs stronger I have heard that aquatic exercises can help older people who cannot stand for a long time. I am in my mid-60s. Are there exercises that can make my legs stronger? There are many ways to work the lower body in a swim­ming pool. Many classes offer standard leg raises done in the shallow end while holding on to the pool wall. You can begin to strengthen and tone your legs just by moving them against the resistance of the water. However, after a while, you may need more resistance. By using water noo­dles around your legs, you can increase the intensity of the exercise, which will help increase leg strength. To begin with, choose your noodle. (Noodles used by chil­dren are usually not strong enough. Look for those espe­cially made for water exercise or water aerobics.) Quadriceps and hamstrings/front and back top of thigh Stand up straight with your back flat against the pool wall. Hold the ends of the noodle so it is in a 'U' shape. Push it underwater and step on it in the middle of the U with the right foot. Then let go if you can. Lift your right knee up and straighten your right leg and press out with the heel. Bend the knee again and replace the foot on the pool floor. Keep your lower back against the wall and abdomi­nal muscles contracted. Do eight to 12 repetitions. Then repeat with the left leg. Outer thigh Stand up straight, with the noodle in the same position as before. Stand with your left side to the pool wall, but do not lean on it. Lift your right leg straight out to the side. Try to turn your foot so the heel leads and toes are slightly turned in. Make sure the toes do not point up. Lift until you feel the hip and outer-thigh muscles contract. Be care­ful not to tip the body sideways as you lift. Do eight to 12 repetitions. Then repeat with the left leg. Inner thigh Stand up straight with the noodle in the same position as before. Stand with your left side to the pool wall, but do not lean on it. Lift your right leg straight out to the front, about waist high. Keeping the knee and back straight, press your right foot towards the wall, touching it if you can. You are bringing the right foot and leg across in front of the body. Bring the leg back, only going as far as you can without swinging the hips out to the side. The leg is merely going from its position in front of the body to the pool wall. Do eight to 12 repetitions and repeat with the left leg. Quadriceps Stand up facing the pool wall. Hold the ends of the noodle so that it is in a 'U' shape. Push it underwater and step through it with your left foot. Place your left foot on the pool floor. You are now straddling the noodle with both feet on the floor. Bend your right knee and catch the noodle behind you with your right foot or ankle. Keep the body straight and press the right foot and noodle towards the floor. Slowly, bring it back up. For this exercise, you are just straightening and bending the knee. Do not push the leg back at all. Be careful not to tip the body forward as you lift. Do eight to 12 repeti­tions. Then repeat with the left leg. Water marching To begin with, stand up straight and breathe evenly, make continuous strides as if marching on the spot, extending arms and legs as far as you can. The resis­tance created by the water will keep the march in slow motion. Stretch your limbs to the full, pointing your toes and pulling your arms vigorously back and forth. Start with two minutes or as long as it makes you slightly breathless. Simply aim for a good, rhythmic walking movement. Standing kickbacks Stand an arm's length away from the pool wall. Keep your shoulders relaxed, your feet together and arms hanging by your sides. Breathe normally. Rest both of your hands against the pool side at shoulder height. Keep your arms straight. Bend your knees a little and tuck in your bottom as you do so. Using your hip and thigh muscles, raise your left leg and swing it back gently. Keep the supporting leg bent a little and don't raise your leg too high. Standing calf raise Stand near the pool wall with its support. Slowly raise both heels as much as you can and hold for 10 seconds, coming back to the original position. Do 20 repetitions. Benefits of exercising in water The physical properties of water make it a highly de­sirable medium in which to exercise to treat back pain and other musculoskeletal injuries. Some important properties of water that make exercise easier are: Buoyancy: Water counteracts gravity and helps support the weight of the person in a controlled fash­ion when immersed. This can aid improved balance and strength. The buoyancy of water also permits a greater range of positions owing to the virtual elimi­nation of gravitational forces, particularly for exer­cises that require lifting legs, the heaviest limb of the body for most people. Viscosity: Water provides resistance by means of gen­tle friction, allowing strengthening and conditioning of an injury, while reducing the risk of further injury owing to loss of balance. Hydrostatic pressure: There are powerful effects pro­duced by hydrostatic pressure that improve heart and lung function, making aquatic exercise a useful way to maintain and strengthen heart and lung function. This pressure also aids improvement of muscle blood flow. Often it is easier to start an exercise programme in water before trying it on ground. For example, a range of motion stretches for hip flexors and abductors are generally much easier to try out first in water because legs are supported while the person learns the right positioning. Buoyancy, when doing water therapy exercises, can be increased with the use of floats. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for him write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine February 2012

Simply stretch... But remember not to overdo it I am a 57 year-old man in a job that requires me to be in front of the computer for long hours. As a result, I experience acute pain in my shoulders and neck; recently the condition was diagnosed as myofascial pain syndrome (MPS). Please suggest some exercises to control this condition as well as reduce muscle stiffness. This is a deep, aching, spreading, and sometimes sharp pain. When you rub or massage the painful area, you may feel a painful, tight band or a 'knot'. These knots are known as 'trigger points' as pressing on them can trigger more pain. This pain can be right at the knot or it may spread. For instance, pressing a trigger point at the top of the shoulder may cause pain in both the shoulders and the upper arm. This kind of pain can have many causes. Poor posture, overuse of muscles, and injury to muscles or nearby joints can all cause this kind of pain. Sometimes, trigger points come from injuries to the spine or to the nerves supply­ing a muscle. This pain can involve a single muscle or many muscles. It may be present while you are active or when you are at rest. Although almost any muscle can be involved, some of the most common sites are the neck, shoulders, the head and lower back. There are two types of treatment for it. The first, and most important, is exercise. To reduce or get rid of myo­fascial pain, you can stretch the painful muscle, improve your posture and restore healthy muscle use. Your phys­iotherapist or healthcare team at the gym can teach you some stretches and exercises to do at home. If you keep exercising even after the pain is better, you will help pre­vent the problem from coming back. The second type of treatment—ice, moist heat, and massage—lessens the pain at the trigger points and can be very helpful. During the exercises I have illustrated here, there should be a sense of pull or stretch but no pain. Move slowly and with care during these movements. When you finish a stretch, you should feel slightly better; you should not have more pain on the next day. If you feel sorer, you might have stretched with too much force or the stretch may simply not be right for you. 1. Sit with your hands clasped behind your head. Bend your head forward until you feel a stretch in the back of your neck. Gently pull your head further forward. Hold for about 10 seconds. Repeat three times. 2. Sit holding your hands together behind your back. Tilt your ear towards your shoulder and raise your chin towards the ceiling. This will stretch the other side. Repeat three times. 3. Sit on a chair. Hold on to the chair as shown. Lean your head and torso away from the fixed arm. Re­peat three times. 4. Inhale. While exhaling, push your upper ribs down with your hand and lift your head away, while rotat­ing your head towards the muscle to be stretched. Repeat three times. 5. Sit on a chair with your legs apart. Bend your head and torso down between your knees, round­ing your upper body as much as possible. Hold for about 20 seconds. 6. Stand or sit, as you prefer. Push shoulders forward, stretch the arms diagonally forward and down keep­ing your chin in. Hold the stretch for 20 seconds and re­peat thrice. 7. Stand and put one arm out to the side away from your body, with the elbow straight as shown. Stretch the fingers towards the floor and drop the shoulder. Gradually, stretch your head sideways away from your out­stretched arm. Hold for 10 seconds and repeat three times. 8. Stand straight facing the edge of a door holding on to its handles. Bend your knees as shown and stretch your back. 9. Stand straight with one hand on your hip and the other straight up. Bend to the side with the opposite arm reaching overhead. Keep your pelvis in mid-position. Repeat three times. 10. Lie with your knees bent and feet on the floor. Lift your knees towards your chest. Place your hands behind both the knees and draw them towards your chest. Hold for 10 seconds and repeat three times. 11. Lie on your back with one leg bent. Bring your bent knee over the other leg and push your knee against the floor with the opposite hand. Then, reach with the oth­er arm to the opposite side looking in the same direction. You will feel your lower back and bottom stretching. Hold for about 20 seconds and relax. Click here for view Details Joint rotation The test of this exercise is that the joint should rotate as a hinge and no clicking should take place. Touch the tip of your tongue to the roof of your mouth. Guide your tongue as far back as it can go. Keep the tongue in that position and gently try to open your mouth. Avoid the movement of your lower jaw throughout. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for him write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine January 2012

Strengthen your core Exercise and posture can treat lumbar spondylosis I am a 56 year-old woman. Last month, I was diagnosed with lumbar spondylosis. I don't want to be on regular painkillers to deal with the problem. Could you suggest an easy exercise plan that will help me? Lumbar spondylosis is often characterised by pain and weakness. Individually tailored exercise programmes can help improve pain, particularly if it is chronic. Before be­ginning any exercise programme, however, check with your physician. You should not be in pain before beginning these exercises; and if you do experience any pain, you should stop immediately. Knee to chest This exercise is a simple way to stretch and strengthen the spine. Begin by lying on your back with both legs straight on the floor. Clasp your hands behind one thigh, and slowly pull the leg to your chest, keeping the opposite leg flat on the ground. You can hold the position for up to 30 seconds, and then switch legs. This exercise gently stretches the back as well as the hamstring muscle. Pelvic tilt This exercise can work your core muscles, which include your abdominals and back muscles. Strengthening your core is important for posture and protecting your back from injury. To try this exercise, lie on your back with your knees up, soles flat on the floor. The object is to push your lower back to the floor by pulling your abdominal muscles up and inward. Breathe while holding the position for five seconds. You can repeat this exercise several times as long as you do not feel pain. Hollow back 'Hollow back' is similar to the 'cow' yoga asana. This pose gently stretches the back. Your therapist will have you be­gin on your hands and knees, with your hands under your shoulders and your knees under your hips. Slowly, allow your stomach to sag, without pulling, arching your back gently. Your gaze should be upwards. Slowly, move back to the starting position and repeat if you can. Tail wagging Tail wagging is another exercise that begins on the hands and knees and will test your balance while stretching and strengthening your core muscles. Try keeping your head in a neutral position, looking at the floor. While keeping your shoulders still, shift your weight on to your right knee and try to reach the left hip toward the left shoulder. You do not have to touch your knee to your shoulder; just try to complete the motion. Switch sides and repeat if you can. Single-leg lift It is important to stretch your lower back and align your spine. You can do this by doing single-leg lifts. Lie face-down on the floor. Place your hands under your chin and lift your head up slightly so that it is in line with your spine. Slowly, lift your left leg up by about 6 to 8 inches and hold it for three seconds. Do not flex or point your foot. Put your leg down in the starting position. Now lift your right leg up for three seconds to a similar height. Do this 10 times with each leg to gently stretch your lower back. Arm curls on exercise ball Sit on a medium-sized exercise ball, 12 to 16 inches in diameter, and find your balance point. Grasp hold of two 4-pound weights and let your arms extend down to your sides. Alternately, curl the weights up to shoulder height, holding the weight at the top of the lift for two seconds. Do 10 lifts with each arm; take a 30-second break and re­peat the set. The weights are light enough to not strain any muscles, but the action of doing the curls on the exercise ball will be beneficial for your lumbar area. Crunch An abdominal crunch strengthens not only your stomach muscles but back muscles too. Lie on your back with your feet flat on the floor. Place your hands behind your head or extended at your sides. Contract your abdominal muscles to lift your head, shoulders and upper back off the ground. Hold at the top of this contraction for five seconds, and then lower your body to return to your starting position. Repeat this 10 times. Rest for 30 seconds, then repeat for two additional sets. Oblique pulls This exercise strengthens the oblique muscles on the sides of your abdomen, which help stabilise your spine. Hold a vegetable can or a lightweight dumb­bell—between 2 and 5 pounds—in each hand. Lean to your right side, moving the left shoulder upward. Repeat on the other side; lower your left hand by lifting your right shoulder. Feel the stomach muscles and the lower back working as you con­tinue to alternate from side to side. Repeat 10 times on each side. Physical therapy is often prescribed to relieve problems caused by lumbar spondy­losis. Starting an exercise regime under the supervision of a personal trainer based on the guidelines prescribed by a therapist will help improve your back health. You can do 25 to 40 min­utes of exercise at a health club for about four days in a week. Split these four days into two days of weight training and two days of low-impact aerobic training and add back strengthening and stretching exercises, which I have explained. What to avoid Lying on your back and bringing the knees into the chest is an example of a common lower back stretch that flexes the spine. This is not recommended for people with lumbar spondylosis. Bending down to touch your toes from a standing position is also not recommended. Reach­ing for the toes while sitting can be problematic as well. Don't sit on your wallet, cell phone or anything else that may throw your spine out of balance. As staying still is bad for your back, don't just pick a position and stay in it. Instead, adjust your seat and make slight adjustments to your position every 15-20 minutes. Points to remember Water is important for the spine and back. For example, intervertebral discs consist largely of water (at birth, discs are about 80 per cent water, although this usually declines with age). Therefore, keeping the body well hydrated by drinking water regularly is important to nourish the spinal discs and keep them healthy. Maintain a healthy weight. Try to decrease your intake of sugars and hydrogenated oils and increase your daily intake of fibre. Ideally, you should consume 35 gm of fibre. Get better sleep. Seven to eight hours of sleep is a must for optimal health. Relax more often to lower stress levels. Find time for yourself throughout the day to focus on your breathing and clear the clutter from your mind. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine December 2011

Train your body Build muscle and beat diabetes Gaining muscle and getting into shape are not as difficult as they sound. After getting rid of the initial soreness (as il­lustrated in this column in the October issue of Harmony- Celebrate Age), it's time to overcome other hurdles. Step 1 Cut back and simplify your resistance training programme. Instead of training five or six days a week like you did 20 years ago, try doing three full body workouts per week. This programme will also work well for beginners. If you can, start each workout with either barbell dead-lifts or squats, which cause a rush of testosterone and growth hormone (see www.bodybuilding.com). If injuries pre­vent you from doing these exercises, simply substitute another leg exercise such as leg presses, which will have a similar effect. Step 2 Work out for no longer than 60 minutes at a time while doing resistance training. Going over this time limit causes the body to produce a lot of the stress hormone cortisol, which, according to Optimum Anabolics by Jeff Anderson, breaks down muscle tissue. With less circulating testos­terone and growth hormone, you will be susceptible to muscle wasting. Get to the gym and get out quickly. Step 3 Decrease your total volume to compensate for stunted recovery ability. Volume means the number of sets that you perform of a given exercise. Instead of cranking out set after set, use targeted training techniques to extend your sets. Drop-sets are one example, done by performing one set of an exercise and then decreasing the weight and immediately doing another set. Rest-pause training is an­other example. You set the weight, do 10 reps (repetitions), rest 20 seconds, do as many reps as you can, rest another 30 seconds and do a final set to exhaustion. Step 4 Take natural supplements to improve recovery time and increase lean mass; for example, whey protein. Also take a multivitamin and an omega-3 supplement for overall health. Step 5 Consume 1 gm of protein per pound of your body weight. You may need to reduce carbohydrate intake slightly be­cause of slowing metabolic rate. Be sure to get at least 25-30 per cent of your calories from healthy fats, which support hormonal function and aid heart health. Tips and warnings Always get seven to eight hours of restful sleep every night to support proper recovery and hormonal function. Never train with heavy weights unless you have prop­erly warmed up. Exercising to reduce diabetes Exercise can play the most effective role in your treatment. Step 1 Undergo a checkup at your family physician's clinic before you begin any type of exercise programme. This will serve as your baseline information and tell you how much work you have ahead and how much progress you have made along the way. Most checkups include a comprehensive physical examination, a complete blood test (including fasting blood glucose), your height, weight and a resting electrocardiogram. The results of these tests will help your physician outline a sound exercise programme and let you know what you need to look out for as you exercise. Step 2 Calculate your exercising heart rate range. You will want to stay within this heart rate range to lose weight, lower blood glucose level and increase cardiovascular fitness without overdoing it. A good place to exercise is within 50-70 per cent of your maximum heart rate. Here is how to calculate your target heart rate range: Subtract your age from 220. Subtract your resting heart rate (in beats per minute) from the result of Step 1. Multiply the result of Step 2 by .50 (representing 50 per cent). Add your resting heart rate back onto the value com­puted in Step 3. Follow Step 1 through 3 using .70 (representing 70 per cent) and add your resting heart rate to the result. For example: A 55 year-old man with a resting heart rate of 70 bpm should exercise between 117 and 136 beats per minute: 220 - 55 = 165 - 70 = 95 x .50 = 47.5 + 70 = 117.5 bpm 220 - 55 = 165 - 70 = 95 x .70 = 66.5 + 70 = 136.5 bpm. Step 3 Check your resting heart rate before beginning the ex­ercise routine and for one minute after finishing. Both should drop as you become fitter. Record the results in a notebook. Step 4 Check your blood sugar level before you begin exercising. Be sure that it is within safe range before you start exer­cising. Your doctor will advise you on the correct range for your specific condition. It is also a good idea to carry something sweet like hard candy in case your blood glu­cose drops while exercising. Step 5 Exercise within your heart rate range. Start slowly; plan to exercise for 10-15 minutes in the beginning and increase your duration (approximately 10 per cent per week) until you can comfortably exercise for 45 to 60 con­tinuous minutes. Step 6 Make a goal with your registered dietician and doctor to expend at least 500 calories per day. This will result in you losing 1 pound of fat per week until you reach your target goal. Reducing weight may help you reduce the amount of medication you are taking and lower your glucose. Step 7 Pay close attention to the condition of your feet. Keep them clean and dry at all times. Many diabetics have neu­ropathy, which prevents them from sensing pain from blis­ters or infections. Make sure that your shoes fit properly; your socks are free from wrinkles; and you don't develop hot spots that can turn into blisters (these can turn into serious infections). Tips and warnings Begin easy—10-15 minutes a day for the first week. Re­cord your results in a notebook and share them with your doctor. Stay well hydrated during exercise. Never increase the intensity and duration of exercise at the same time. Aerobic exercise Brisk walking, running, swimming and cycling are types of aerobic exercises that can be done by most people, even if you already have a chronic condition. Thirty minutes or more of aerobic exercise on most days of the week is good. If you have any conditions that concern you, consult your doctor before an exercise programme. Strength training In addition to regular aerobic exercise, strength training is also recommended. If you are new to strength training or have been inactive for a while, consult a trained exercise professional to help you get started. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine November 2011

Sweet gain Protect muscles from injury despite diabetes I am a 55 year-old diabetes patient. Though I walk regularly, my muscles become sore quite easily. I have heard that regular exercise helps older adults protect their muscles from soreness and injury. Please suggest exercises that could help. Muscle soreness is described as muscle pain, soreness or stiffness that occurs during the day or after exercise. It's also felt upon the start of a new exercise programme; change of exercise routine; or dramatically increasing the duration or intensity of a routine. Although it can be alarming for beginners, delayed onset is a normal response to unusual exertion and is part of an adaptation process that leads to greater stamina and strength as the muscles recover and strengthen. ABDOMINAL EXERCISES You can have toned abdominal muscles (also called abs) at the age of 55. Toned abs not only look good, they lend good posture and support the lower back. Consider your current physical fitness and any chronic conditions or limitations before choosing abdominal exercises. Here are some you can safely and effectively perform. Bicycle manoeuvre To start, lie down with your lower back pressed to the floor. Put your hands behind your head to support your neck and lift your head and shoulders off the ground. Lift your legs to a 45° angle. Now move your legs as though you are riding a bicycle but bring your left knee to your right elbow and then your right knee to your left elbow. Do 10 to 25 repetitions (or reps). Vertical leg crunch Lie down and press your back to the floor. Raise both legs until your feet are pointing to the ceiling. Cross your legs at your ankles and bend the knees slightly. Put your hands behind your head. Now use the abdominal muscles to lift your shoulders and head off the ground, as if you were doing a regular abdominal crunch. Slowly, lower your head and shoulders back down. Do 10 to 25 reps. Reverse crunch Lie on your back and press your lower back to the floor. Raise your feet up until your knees are bent at a 90° angle. Cross your ankles. Put your arms out to your sides to stabilise your body. Now lift your hips off the floor, while keeping your lower back on the ground. Slowly lower your hips back down. Repeat 10 to 25 times. Plank Lie down on your stomach. Move up into a push-up position with your hands directly under your shoulders. Make sure your body is in line from your head to your hips, torso and legs. Rest your knees on the floor if necessary. Hold for 30 seconds and build up to one minute. Tips Do one to three sets of these exercises at least twice a week. Allow for two days in between each abdominal exercise routine. When using your hands to support your head and neck, press your head back into your hands so you don't strain your neck. Warning Consult your doctor before starting this routine, especially if you have back problems. Stop if anything hurts or you feel uncomfortable. Next week: How to build muscle You can gain muscle and get into shape. Unfortunately, nature throws you a few obstacles because your metabolic rate slows with age. Moreover, your body's production of anabolic hormones also declines. To top it all, recovery happens more slowly. By adapting your training and diet to these obstacles, you can overcome them and build muscle at 55 years old and beyond. Read more next time. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine October 2011

Step up It's time to manage your weight Last month, I suggested stretching exercises for a reader who was battling an acute case of plantar fasciitis. As a result, he had stopped exercising and gained weight. After tuning your body to stretching, here's a gentle weight loss programme to follow. Make sure you do a complete warm-up before starting the exercises and a complete cool down at the end of the session. Push-ups Start by lying face down on the floor. Place your arms next to your shoulders. Push up, keeping your body straight. Lower. Repeat 15 times. Lying fly Grab two light dumbbells. Lie on the floor, facing upwards. Keeping your arms straight, raise the dumbbells to meet above your chest. Lower slowly and hold just above the ground. Repeat 15 times. Try to keep a little bend in your elbow so as to not cause injury. Do 15 lying flys. Shoulder press Start with the dumbbells at about ear level. Raise them above your head and lower again. Do 15 repetitions (also called reps). Dumbbell laterals With both arms pointing towards the ground, hold the dumbbells in front of you. Raise them in a circular motion until your arms are parallel with the floor. Hold; then return to starting position. Do 15 reps. Seated triceps extension From a seated position, hold one of the dumbbells above your head with both hands. Make sure the weight is not too heavy. Lower the dumbbell behind your back, keeping the upper arm as vertical as possible. If you find this too easy, use one arm instead of two. Do 15 reps. Lying triceps extension Lie down on the floor, facing upwards, holding a dumb­bell in each hand, with arms extended towards the ceiling. Lower the dumbbells towards your head while trying to keep your upper arms as still as possible. Return to the starting position. Do 15 reps. Lying dumbbell pullover Start by lying on the floor, holding a dumbbell in each hand with palms facing your feet. Lower the dumbbells to the floor above your head. Don't let them touch the floor to keep tension on your muscles. Return to starting position. Do 15 lying dumbbell pullovers. One-armed row Put your left knee on a chair, lean forward and support your body with your left arm on the chair. Hold a dumbbell in your right hand. Lift the weight by raising your elbow towards the ceiling. Hold. Return to the start. Do 15 reps. Dumbbell bicep curl Either standing or seated, hold a dumbbell in each hand, lowered towards the floor. Raise the right dumbbell to­wards your chest, while keeping your upper arm relatively still. Start with your palms facing your sides, then curl the dumbbell as you raise it, so your palm faces your chest. Repeat with the left dumbbell. Do 15 reps. Dumbbell squats Holding the dumbbells by your sides, bend at the knees and lower your body until your thighs are perpendicular with the ground. Try to push your hips back as you lower, so your knees don't extend over your toes. Hold before returning to starting position. Do 15 dumbbell squats. Stiff-legged dead-lift From a standing position with the dumbbell held in front of your thighs, bend forward from the waist. Lower the dumbbells to your knees, then return to standing position. Keep your legs straight with a slight bend in the knees. If you have any back problems, bend your knees to take the pressure off your back. Do 15 reps. Lying bridge Lie on the floor, with face up and feet on a chair. Raise your waist toward the ceiling; hold before returning. Do 15 reps. Do these exercises every alternate day (thrice a week) and keep yourself hydrated. Cut down on sugar and fat in your diet, get more fibre and break your meals into more fre­quent, smaller portions. Start now! Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine September 2011

Well heeled Stretching exercises for plantar fasciitis I am a 59 year-old man. In my younger days I used to exercise regularly. However, as I approached my 40s, I gradually stopped exercising. Now my weight has increased and, of late, I have been experiencing acute heel pain. Is there something that I could do to reduce my weight and deal with the pain at the same time? Exercise is an important weight loss tool, but how much of it is needed varies from person to person. Guidelines recommend at least 250 minutes per week, which comes to about 50 minutes, five days a week. As you are a beginner, start with three days of cardio for 15-30 minutes, gradu­ally adding time each week to give your body time to adapt. Stretching exercises will be very helpful to reduce heel pain (plantar fasciitis). Stretching should not cause pain, but rather a pulling feeling. Try to do each exercise two or three times during the day, not necessarily in one sitting. Incorporate the exercise into your workout regime. Exercises for plantar fasciitis Plantar fasciitis causes many people intense heel pain in the morning at the time of taking their first steps after getting out of bed. This pain comes from the tightening of the plantar fascia that occurs during sleep. Stretching or massaging the plantar fascia before standing up will help reduce heel pain. ' Before sitting up, stretch your foot by flexing it up and down 10 times. While seated, roll a rolling pin or tennis ball with the arch of your foot. If you are able to, progress to doing this exercise while you are standing up. After these exercises, put on your shoes (with orthotics inside them) or wear supportive sandals. Do not start the day walking barefoot on hard floors or tiles, or your heel pain will return. Heel pain relief exercises (during the day) Calf stretch: Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind your other leg. Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg. Hold the stretch for 15 to 20 seconds. Repeat four times. Achilles tendon stretch: Stand on a step. Slowly let your heels down over the edge of the step as you relax your calf muscles. Hold the stretch for about 15 to 20 seconds, then tighten your calf muscle a little to bring your heel back up to the level of the step. Repeat four times. Hamstring stretch: Extend one leg in front of you with the foot flexed. Bend your other knee and lean back slightly. Your pelvis should be tilted forward. Keep your upper body upright as you hold the stretch for 10-20 sec­onds, then switch sides. You should feel the stretch up the back of your extended leg (all the way up your calf and thigh). Marble lifts: Place marbles on the floor next to a cup. Us­ing your toes, try to lift the marbles up from the floor and deposit them in the cup. Repeat the exercise 15 times. Towel stretch: Grab a rolled towel at both ends, holding it under the ball of your foot. Gently pull the towel towards you while keeping your knee straight. Hold this position for 15 to 20 seconds. Repeat four times. To burn weight, low-intensity exercises would probably be best even though they don't burn off as much energy as high-intensity activities. The reason is that low-intensity exercises don't upset or stress the body too much when completed and as a result can help regulate the appetite. Activities with lower intensity also tend to burn a greater degree of fat or fuel, even though less total energy is burnt per hour. This can be adjusted by simply increasing the duration of the session. The first step is to commit to your weight-loss programme every day. No matter what else is going on in your life, remind your­self of your fitness goals and give your workout the priority it deserves. Write it down and treat it just like any other ap­pointment that you wouldn't miss. And if you find yourself falling off the fitness wagon, don't worry, this programme will help you dig deep and find the strength to keep going. For details on the weight-loss programme, wait for the September 2011 issue of Harmony-Celebrate Age Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine August 2011

Building strong knees Work on better stability for the long run It's important to build knee strength and stability for any kind of exercise regime. Here are some easy exercises. Hip abductors (inner thigh)/groin muscle and inner quad muscle strengthening: Sit in a chair, put your fist between the knees and squeeze them together. Hold and count to 10. Relax to the count of three. Do 10 repetitions. In another exercise, lie on the floor on your right side, shoulder and hips aligned. Prop your head up with your right hand. Place the left hand in front to help you balance. Bend your left leg and bring it to the floor in front of you. Raise your right leg 10 inches off the floor and hold for a second, then slowly lower. Lift 10 times on each side. Hip abductors (outer thigh/hip) strengthening: Lie on the floor on your right side, shoulder and hips aligned. Bend your right leg (leg on floor) to 90°. Slowly, raise your left leg about 18 inches, hold for a second and lower gradually. Do 10 repetitions. Repeat on the other side. Gluteal strengthening (backward leg swing): Hold on to the back of a chair. Swing one leg back diagonally, until you feel your hips tighten. Tense muscles as much as you can and swing your leg back a couple more inches. Return leg to the floor. Repeat 10 times. Switch sides. Calf raises (strengthens calves and ankles): Stand with feet shoulder-width apart. Do not lock knees. Place one hand on the wall. Raise your heels as high as you can and slowly lower to starting position. Do 15 repetitions. Gradually, do this exercise on one foot at a time. You could also try placing the balls of the feet on the edge of a stair with heels hanging over the edge. Lower the heels gradually, yet as far as you can. Then raise your heels gradually yet as high as you can (stand on toes). Do 15 repetitions. Balancing knee exercises: Hold on to the back of a chair. Stand on one leg for one minute. Switch sides. As your balance improves, use only one hand for support. Gradually you should be able to do this by using one finger for support, progressing to letting go, but keeping your hands within a couple of inches above the chair for balance. Do not lean on any one side. To increase difficulty, shift weight on to the ball of the foot. Stretching exercises for knees Note: If you experience knee pain or have a knee injury, ask your doctor for appropriate exercises. How often to stretch: Stretching exercises may be done daily, but every second day or three times a week is enough. Stretching is often prescribed twice a day or more by physical therapists to treat knee pain. How long to hold a stretch: The stretch should generally be held for a total of about 60-90 seconds. Holding a stretch for 30 seconds only requires two or three repetitions. Some people prefer to do more repetitions of five or 10-second stretches or just one 60-second stretch. Before stretching, warm up with five to 10 minutes of low-impact aerobics (e.g. walking, stationary bike). Warmed up muscles are more responsive to stretches and less likely to tear. Stretches should be performed in a controlled fashion. Calf muscles stretch: To stretch the left calf muscle, step back with your left leg, forward with the right. Bend the right knee (keep left leg and back in a straight line as you lean forward) until you feel a gentle stretch in the left calf. Do not roll foot out to the side. Keep heel flat, foot forward. Hold for 30 seconds. Repeat on the other side. Quad muscle stretch: Stand and bend your right knee. Hold your right ankle from the front and bring heel to buttocks with your hand. Keep the knees together—neither arch your back, nor let the leg go to the side. Point your knee towards the floor. Tighten buttocks and tuck tailbone under to maximise the stretch. Hold for 30 seconds, before repeating on the left side. Hamstring stretch (standing position): Keep one leg on the floor and put the other foot on the chair with leg straight. Bend forward at the hip. Hold for 30 seconds. Repeat on the other side. (Do not try touching your toes as this will stretch your back; the goal is to isolate your hamstring muscles that are being supported by the chair.) Hamstring stretch (sitting position): Straighten one leg, keeping heel on the floor. Lean forward at the hips, keeping your back straight. Don't try to touch your toes. Hold for 30 seconds. Repeat on the other side. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine July 2011

Joint strength Knees are the fulcrum of your body Walking—its merits were discussed in last month's column—is impossible without knee strength. As fatigued muscles cannot adequately support the knee joint and/or absorb shock before it gets to the knee, we need to strengthen the muscles that support our knees. Strengthening exercises help make the muscles tight, so follow them up with stretching exercises. However, when doing stretching knee exercises, go slowly and do not overstretch. Warning: You need to increase the duration of your knee exercises gradually to avoid overuse injuries and knee pain. Tips: Walk or ride a stationary bike for five minutes to warm up the muscles. Keep breathing throughout. Types of knee exercises: Strengthening, balancing and stretching exercises Strengthening exercises These exercises should be done thrice a week on nonconsecutive days to avoid overuse injury and allow healing. Beginners could start with five repetitions of each exercise, or less if the exercise is difficult. If you do not have post-exercise pain, add a couple of repetitions each week until you reach 10-15 repetitions. After you can handle one set, add a second set of 10-15 repetitions. When two sets become easy, add a third, giving 30 seconds of rest between sets. Pick a different strengthening exercise for every session for a particular muscle group. Mix strengthening exercises as you progress. Do not exercise the same muscle group on consecutive days. Quadriceps strengthening contractions Sit on the edge of a chair. Extend your legs and touch heels to the floor. Keep your knees straight as possible. Tighten thigh muscles. Hold for a count of 10. Relax for a count of three. Repeat 10 times. You can do this several times a day. Build up to two or three sets of 10 repetitions at a time. Quad strengthening leg lifts Lie flat on your back. Bend left knee at 90°, keeping foot flat on floor. Keeping the right leg straight, lift it until the right foot is as high as the left knee; hold for a count of three. Repeat 10 times. Switch sides. Work up to 10 sets of 10 over several weeks. Safety tip: Lift one leg at a time; the opposite leg should be slightly bent with foot on floor. Quad strengthening short-arc leg extensions Lie on the floor with a rolled-up towel under your thigh. Keep your leg straight and raise your foot about six inches off the floor. Hold for five seconds. Slowly lower your foot, bending your knee. Do 10 repetitions. Switch sides. Quad strengthening knee dips Stand with knees slightly flexed. Make sure your kneecaps and toes are pointed straight ahead. Lift one leg up and balance on the other leg. Slowly lower yourself up and down only a few inches. Keep the knee of the leg you are balancing on slightly flexed. Stand straight. Do 10 dips. Switch sides. If you feel pain in your knees, start with fewer dips. Quad strengthening partial squats Stand with back straight, knees hip-width apart and pointing straight ahead. Slowly lower and move your hips backward as if you were sitting in a chair (don't bend your knees beyond 90°; if that's too difficult, bend even less). Hold the position for a count of five. Do 10 squats. Stop if you feel pain in your knees. Safety tip: To reduce pressure on the joint, ensure your knees do not extend beyond your toes Seated hamstring strengthening contractions Do only one hamstring exercise (if you are doing just one set). If you have progressed to two sets, pick two different exercises or do the same one twice. For this one, sit on a chair with knees bent at 45° and heels on floor (toes up). Without moving heels pull back on them, digging them into the floor. Feel the tension in you hamstrings. Hold for count of 10. Relax for a count of three. Do 10 repetitions. Lying hamstring strengthening contractions Lie on your back, knees bent at 45°. Dig heels into the floor. You will feel tension in your hamstrings. Hold for a count of 10 seconds. Relax for a count of three. Do 10 repetitions. Hamstring strengthening curls Lie on your stomach. Place your left foot on the back of the right heel. Slowly pull your right heel toward your hips, resisting with the left leg. This contracts the hamstrings. Hold for a count of 10. Relax for count of three. Do 10 repetitions. Walking backwards helps develop hamstrings and results in less strain on your knees. —Next month, more on knee stability, hip strengthening and stretching Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony - Celebrate Age Magazine June 2011

Easy go, easy win Walking can help you regain strength I am a 60 year-old woman and have always led an active life. I used to run regularly, but stopped at the age of 55 because I started suffering from pain in my knees. I want to go back to running but I am a borderline diabetic and have been advised against it. Can you suggest an exercise plan that will be easy on my knees and make me active? Running is generally too taxing for the body. Instead, start with exercises you are already comfortable with. Don't rush into it; if you start slowly, you are less likely to injure yourself. Starting slowly also helps prevent soreness. High-intensity exercise is not proportional to health benefits. For example, walking—a seemingly simple and boring activity—is excellent for good health and can be gradually intensified for consistent benefits. It doesn't tax the body, increases overall blood circulation, and is fantastic for overall health. If at all you intend to run, consult a physician or a personal trainer to make sure it is suitable for your age and level of fitness. Tips to keep you going Choose activities you enjoy. Make exercise part of your daily routine. Exercise with a group for social interaction as well as physical fitness. Keep a written record of progress. Exercise to music. Set realistic goals for what you want to accomplish. Select loose, comfortable clothes. Dress for warmth in the winter and coolness in the summer. Wear shoes with firm soles and good arch support. Pay attention to your body. Forget the saying: No pain no gain. Simple strength exercises Each exercise should be done eight to 10 times for two sets. Remember: Complete all movements in a slow, controlled fashion. Don't hold your breath. Stop if you feel pain. Stretch each muscle after your workout. Wall push-ups Place both hands flat against the wall; slowly, lower the body and push away from the wall to return to starting position. Chair squats Begin by sitting on the chair. Lean slightly forward and stand up from the chair. Try not to favour one side or use your hands to help you. Bicep curls Hold a weight in each hand with your arms at your sides. Bending your arms at the elbows, lift the weights to your shoulders and then lower them to your sides. Shoulder shrugs Hold a weight in each hand with your arms at your side. Shrug your shoulders up towards your ears and then lower them back down. Next week, I will illustrate some knee exercises. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony Magazine May 2011

For a healthy heart Exercise with Madhukar Talwalkar "Just like we once learned that people with heart disease benefited from aerobic exercise, we are now learning that guided, moderate training has significant benefits," Mark Williams, American Heart Association (AHA) group chair, has often been quoted. "Patients who have had cardiac events are often apprehensive about returning to this type of activity, or doing things in their daily lives that might be perceived as strenuous. This helps physicians and patients understand what they should be doing and what they should avoid. Now we know that they can return to the active things they enjoy doing." This approach has been guiding clinicians in the US for over a decade. Warning: There are certain conditions (unstable heart disease, uncontrolled hypertension or arrhythmias, infections in and around the heart, Marfan's syndrome, etc) for which resistance training is not recommended. Recommendations on resistance training Exercise in a rhythmical manner, with slow to moderate yet controlled speed. Exhale on the effort, inhale on the return (for instance, in a shoulder press, exhale when you exert to push the weight up, inhale when you relax and bring it down). Avoid holding your breath and ensure a full range of motion. Alternate between upper and lower body workouts. Choose weights and the appropriate number of repetitions per set according to your health, frailty and age. Limit the workout to a single set thrice a week. Involve muscle groups of the upper and lower body: chest press, shoulder press, triceps extension, bicep curl, lat pull-down, lower-back extension, abdominal crunch/curl, quad extension, leg press, leg curl, and calf raise. Don't overdo resistance training when you start exercising. Your muscles need time to get used to it. Encourage good practice to avoid soreness and injury. For elderly patients, vision, balance, stability and orthopaedic conditions should be considered. Weight machines and/or seated exercises may be safer. All heart patients should be evaluated before beginning a strength-training programme to ensure safety. If your doctor approves, follow these guidelines: After heart surgery—you can begin a range of motion exercises in the hospital. After four to six weeks of recovery, you can participate in a cardiac rehabilitation or aerobic activity programme. Two to three weeks into the programme, your healthcare provider should check your sternum for healing and stability before you can begin weight training. Weight lifting that requires pulling of the sternum should be avoided for about three months. After a heart attack (myocardial infarction or MI)—you can begin a range of motion activities two days after your heart attack, depending on your condition. After four to six weeks of recovery, you can participate in a cardiac rehabilitation or aerobic activity programme. Two to three weeks into the programme, you can begin weight training. After angioplasty—you can start a cardiac rehabilitation or aerobic activity programme after a week of recovery. After two to four weeks, you can begin weight training. Precautions If you experience breathlessness or fatigue during any activity, slow down or stop the activity. Elevate your feet when resting. If the problem persists, call your doctor. Do not exercise if you are feeling unwell or running fever. You should wait for a few days after all symptoms disappear before restarting the exercise programme, unless your doctor gives other directions. Stop the activity if you develop a rapid or irregular heartbeat or heart palpitations. Check your pulse after you have rested for 15 minutes—if it's above 120-150 beats per minute, call the doctor for further instructions. Sample exercises A chest press or another pushing exercise. A rowing exercise or another type of pulling exercise. A major leg muscle exercise like a squat or leg press. A core body exercise, like sit-ups or crunches. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony Magazine April 2011

Heart safe Resistance training for cardiac patients I am a 55 year-old heart patient. Can I do weight training exercises? UNDER THE SUPERVISION OF AN EXPERIENCED PERSONAL TRAINER, WEIGHT (RESISTANCE) TRAINING IS SAFE. How should a heart patient begin? Ask your doctor if you may begin an exercise programme that includes weight-training. If you have not participated in aerobic exercise, enrol in an aerobic exercise programme for two to four weeks before adding weight training to your regime. Speak to a cardiac rehabilitation exercise specialist or trainer working with heart patients and older adults (if this applies to you). Learn the proper techniques to avoid injury: breathe correctly (naturally, not holding your breath, exhaling during exertion and inhaling during relaxation); avoid straining; use proper posture; and understand the motion. A supervised cardiac rehabilitation programme may be recommended for some individuals to monitor signs and symptoms of ischemia (decreased blood supply to the heart muscle), blood pressure, heart rate and lifting techniques to avoid complications and injury. Recommendations for initial weight training prescription: Weight training should be performed… in a rhythmic manner, at a moderate-to-slow controlled speed. through a complete range of motion, avoiding breath holding and straining by exhaling during the contraction or exertion phase of the lift and inhaling during the relaxation phase. alternating between upper and lower body work, to allow for adequate rest between exercises. The initial resistance or weight load should… allow for, and be limited, to 8-12 repetitions per set for healthy, sedentary adults; or 10-15 repetitions at a low level of resistance (less than or equal to 40 per cent of maximum one repetition) for older adults (more than 50-60 years of age), frail persons, or cardiac patients. be limited to a single set, performed two days per week, and involve the major muscle groups of the upper and lower extremities—chest press, shoulder press, triceps extension, biceps curl, pull-down (upper back), lower back extension, abdominal crunch/curl-up, quadriceps extension or leg press, leg curls (hamstrings), and calf raise. While traditional prescriptions for weight training involve performing three sets of repetitions, single and multiple set programmes actually provide nearly the same relative improvement in muscular strength during the initial training period. For the average person beginning strength training, single-set programmes are recommended over multiple-set programmes at least two days per week—they are highly effective, less time consuming, and promote adherence. A comprehensive programme of eight to 10 exercises can be accomplished in 15-20 minutes and should be done after the aerobic component to ensure adequate warm-up. Gradually, increase the exercise level by changing any variable—increase resistance; increase repetitions; increase the number of sets; and decrease the rest period between sets. Next month: Exercises, guidelines and precautions for a stronger heart. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony Magazine March 2011

After surgery Fight stiffness after lumpectomy The following exercises use self-weight to increase the range of motion: Atlas: Stand in front of a wall. Put your hands with your palms flat against the wall. Gently bend your head forward and step back slowly from the wall. Feel the stretch in your shoulders. Champion: Bend the elbow of the mastectomy side and gently pull your arm up over your head with your other hand. Hold for a count of five and feel the stretch down your side. Elbow push: Hold the arm on the affected side by placing the other hand on that elbow. Keep your arm at shoulder level and use the other hand to gently push it up towards your head. Hold for a count of five. Strengthening exercises Side raises: Hold a light weight (2 kg bottle/container if you don't have weights) in the hand on the affected side. Use both your arms to work muscle groups evenly. While sitting, raise your arm up and over your head. Put your other hand on your elbow to help raise the arm. Overhead press: Hold a light weight in the hand on the affected side. Use both your arms to work muscle groups evenly. While sitting, bend your elbow with your palm facing the ceiling. Put your other hand on your elbow and raise your arm over your head. Work towards doing both arms together. Bench press: Lie on your back, with weights in both hands. Bend your elbows with your arms out to your sides. Bring them up and over your head. Crossovers: Lie on your back with your arms outstretched and weights in both hands. Bring your arms up off the floor and get them to meet in the middle. Slowly, lower your arms to the starting position. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony Magazine February 2011

Mood elevator Exercise to feel good I have been living alone after my husband's demise. Of late, I have been feeling lonely and unhappy. My doctor tells me these are signs of depression. Can you suggest exercises that could help me deal with my condition? Depression drains you, making every task seem monumental. Part of moving past it includes putting on your workout clothes. Keep your routine simple and doable—it will make it easier for you to get started. Set simple goals. It doesn't take much exercise to lift your mood, so you don't have to train for a marathon. Promise yourself you will walk around the block at least three times one day. The next day, walk more. Go easy on yourself. Try to feel good about what you can do. Whether you get out and work in the yard, take the dog for a walk or go up and down the stairs a few times, it all counts. This is not the time to kick yourself. Do what you usually enjoy. When you're depressed, it's hard to enjoy anything. But think about what you normally like to do. If yoga makes you feel good, spend a few minutes on a few simple poses. If you like fresh air, go for a walk. Even a small change in your mood can make a difference. Regular exercise has been proven to: Reduce stress Ward off anxiety and feelings of depression Boost self-esteem Improve sleep Exercise also has these added health benefits: It strengthens your heart It increases energy levels It lowers blood pressure It improves muscle tone and strength It strengthens and builds bones It helps reduce body fat It makes you look fit and healthy Types of exercise to combat depression Biking Dancing Gardening Golf (walking instead of using the cart) Jogging at a moderate pace Low-impact aerobics and strength training Tennis Swimming Walking Yoga Sample yoga asana to fight depression This 10-minute stretch offers a gentle routine perfect after a workout or on its own for relaxation. The stability ball offers extra support and, for some moves, the added balance challenge. You may need to adjust your position if you have a larger or smaller exercise ball. arm up with light cardio or do this workout after your regular workout Complete each exercise, modifying when necessary Do as often as you like for flexibility and relaxation High Lunge to Warrior II and Side Angle Get into a lunge position on the ball, right leg forward, the left leg straight out behind you. Square the hips forward and sweep arms overhead and slightly back. Hold for 3-4 breaths and then lower the arms and turn the body to the side, stretching through the arms. Hold for 3-4 breaths. From there, take the right arm down and place the hand on the floor while stretching the left arm straight up. Hold for 3-4 breaths. Repeat series on the other side. Side Child's Pose On the knees, roll the ball out, relaxing the head and stretching your chest. Shift hips to the right and gently roll the ball to the left, stretching your back; repeat on the other side. Hold each stretch for 15-30 seconds. Hip Stretch Lie on the floor with the right foot on the ball, knee bent. Cross the left foot over the right knee and use the right foot to gently roll the ball in to stretch the right hip. Hold for 15-30 seconds and repeat on the other side. Whole Body Stretch Lie face up on the ball and roll down until your back is fully supported. Relax your hips and head and let arms fall to the sides for a front body stretch. Hold for 3-5 breaths. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net If you have a question for Dr Talwalkar write to contact.mag@harmonyindia.org Featured in Harmony Magazine January 2011

Set the pace More exercises for hernia management As discussed last month, pre and postoperative care are equally important in managing hernia. In abdominal curls, start with simply taking the weight off your shoulder blades and holding the 'up' position for a couple of seconds each time. See if you can comfortably do 15 repetitions. If not, stop when you feel you have had enough. If you feel no soreness, try more repetitions 48 hours later. Stop any time it hurts, or if you feel that a hernia or stoma site is responding differently from the surrounding skin. In the latter case, cautiously try it again on your next training day; if the discomfort persists, may be that's the way your abdomen will respond each time. However, if you detect even a slight increase in the response, discontinue training until you have sought competent medical advice. Build up the number of repetitions progressively to three 'sets' of 15, taking a few minutes rest between each set. If you've been able to do this on three consecutive training days without feeling sore on your next training day, then you are ready to move ahead. Building up the workload The next step is nothing dramatic: instead of merely relieving the pressure on the shoulder blades, lift them two or three inches off the floor. It is sensible to check occasionally with the finger tips that as you raise the body the bottom of the rib cage is moving towards the iliac crest of the pelvis (the hips) so that it is definitely the rectus abdominis being worked rather than the hip flexors. Hold the raised position for a couple of seconds each time and work up gradually to sets of 15 repetitions, and then three sets at each session. Stop if it hurts, or if (at any time) you feel sore on the start of the next training session. Reduce number of repetitions until you feel that at each training session you are fully recovered from the previous one. When you can achieve three sets of 15 repetitions on three consecutive training days, you are ready to increase the load again. This will involve nothing more than increasing the movement so that you are raising the torso to an angle of about 45°, following the same stages and taking the same precautions as discussed. A further progression would be to increase the load by holding the hands beside the ears, although you should avoid placing them behind the head. At the final stage, you can increase the movement until you are raising the torso as far as you are able, comfortably, but not in any way rushing the progressions or slackening your precautions against overload. Where to go from here By now you must be feeling reasonably fit, confident in day-to-day activities, and restrained in sports participation like swimming, running (on a good surface, where there is minimal risk of stumbling), riding (with due care while mounting the horse) and amateur cricket. As always, monitor the abdomen carefully for any untoward signs. It would probably be helpful to fit this in between your sets of sit-ups. A more demanding exercise would be to leave the knees in the raised position for sit-ups, and try to bring each shoulder up towards the opposite knee. Exercises you must avoid are ones involving heavy lifting, pulling or pushing. These would involve closing off your throat, thus increasing abdominal pressure and the size of the hernia. Besides, these kinds of exercises do not burn calories efficiently and would not help weight loss. It is natural that there will be some enthusiasts who would wish to take their strengthening programme further on completing the exercises described. They should be aware that all exercises in case of hernia repair mean venturing into uncharted territory and, as already explained, must be undertaken with unremitting caution. The next stage would be to continue the sit-ups programme on a bench inclined at 45°, with the hands held beside the ears to increase the load, and perhaps even ultimately with weights. Before taking this step, seek medical advice, preferably from the surgeon who carried out the repair. Above all: don't push your luck!. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net Featured in Harmony Magazine December 2010

Handling hernia Exercise without strain is the mantra I am a regular at my gym since 2009. However, I have to undergo a surgery for hernia next month. How soon can I resume exercising and what kind of exercises would be suitable? Most hernias are the result of straining, for example when lifting heavy objects, coughing or constipation. Being overweight also contributes to the problem because much of the excess fatty tissue is deposited around the intestine. This increases the pressure on the abdominal muscles and encourages the intestine to protrude through any weak area and thereby form a hernia. You need to keep your weight down, not only to prevent the hernia from getting worse but to make surgery easier. Avoid exercises that involve heavy lifting, pulling or pushing. These close off your throat, which increases abdominal pressure and the size of the hernia. Besides, such exercises do not burn calories efficiently and will not help with weight loss. Do aerobic exercises at a steady rate for long periods, say 30 minutes at a time, which do not involve closing off the throat with effort. Recommended activities include swimming and static cycling. The use of a recumbent exercise bike is ideal. It forces you to use the most powerful muscles in the body, the thigh muscles, even as the sitting position relaxes your abdominal muscles and doesn't exacerbate the hernia. If the hernia is bulging outwards continually, ask your doctor about a temporary truss to hold it back so that you can exercise. Try to exercise aerobically for 30 minutes every other day at a moderate pace. Strengthening your abdominal muscles following hernia repair: In the absence of medical advice, it would be wise to wait for a month before starting a strengthening programme. Strengthening would initially involve sit-ups, or more correctly abdominal curls, on a firm flat surface—ideally the floor. The knees should be raised in order to minimise the probability of using the hip flexors in place of the rectus abdominis. The actual amount of knee raises are a matter of personal choice; try raising them until the heels touch the fingertips; if that feels uncomfortable, lower them slightly. Initially, aim to reduce the pressure of the shoulder blades on the floor, without any obvious bodily movement. In the early stages, rest the fingertips of the appropriate hand over the site of the hernia repair and over the stoma, aiming to detect any obvious difference in the feel of the sites, compared to the surrounding abdominal wall as it takes up the stress. The temptation should always be resisted to join the hands behind the head, which tends to place unnecessary stress on the neck; just keep your arms on the floor with the fingertips monitoring the movement. One vital point: if you have a stoma or a hernia, repaired or otherwise, on no account should you hold your breath while carrying out a task. Holding the breath has the effect of increasing intra-abdominal pressure, which is just about the worst possible situation for a hernia repair. A useful reminder is the 'grunt rule'—if it makes you grunt, don't do it! When doing abdominal curls, think in terms of squeezing the air out as you curl, and it will come naturally to breathe out as you curl up. Any muscle strengthening exercise should be carried out only on alternate days: the muscle is weakened by the exercise, and strengthens in the following 48 hours. Exercise the same muscle every day and the result will almost certainly be to weaken it: a process known as over-training. Be sensitive also to any soreness in the vicinity of a repair, which would indicate that the muscle is responding to local stresses. Only you can judge your progress, and when to move to a more demanding task. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net Featured in Harmony Magazine November 2010

Handy tips And some easy-to-do exercises for you Often, a beginner loses interest in his/her exercise regime within a month. To prevent such lack of motivation, try and follow these steps: If you have been exercising in your basement, join a gym where you can interact with other people and use different equipment. The key to staying motivated might lie in the kind of music that motivates you. Tune in for best results. Make sure the clothes you wear are non-restrictive. Appearance is important as well. If you have a great 'new' pair of workout pants, you may be more motivated to go to the gym. If you have been wearing the same T-shirt you have worn for months, it may be time for a little shopping trip. Focus on your goals. If you have attained them, it's time to set some new ones. Be sure to keep your goals realistic and measurable to prevent discouragement. Once you have an attainable goal, how will you know when you have moved one step closer? If you chart your progress, you will clearly see where you are and where you hope to go. Everyone's routine is different and tailored to suit their convenience. However, if you remember to incorporate these tips into your plan, you might experience success and be motivated to continue your programme. Here are some easy exercises that you could follow: Bodyweight squats: Place your feet about shoulder-width apart. With your torso vertical and a slight arch in your lower back, start the movement by bending the knees. Go only as far down as you feel comfortable. If you can go down until your thighs are just parallel, do so. This is the full range goal. Using leg power, push yourself back up to the start point. Use your grip on the bar only for balance unless you absolutely need to pull yourself up. As you get stronger with squats, don't use the bar. When you can do good, full-range repeats without the bar, you can start using a weight. For this, use two duffel bags (evenly loaded) or two bottles with water (anything that suits you) and hold them at your sides and squat. Abdominal crunches: Lie down flat on your back with your knees bent and your feet on the floor. Hold your hands wherever comfortable (on your chest or beside your head—just be sure you don't pull on your head). The typical crunch is taught by instructing you to simply roll your upper torso forward. This is fine to start with. To increase the effectiveness of the crunch movement, push your chest and head up towards the ceiling while pushing your lower back onto the floor. Your anatomy will automatically cause you to follow a crunching pattern. Hold the top of the movement for one second and squeeze hard. Dumbbell curls (for biceps): Stand with your knees slightly bent, arms at your sides, holding your resistance bags or two dumbbells in your hands. The curl movement happens only at the elbow. With your upper arm pinned at your side and bending only at the elbow, lift the weight up to shoulder level. Your palm should be facing forward all the way up and all the way down. Squeeze hard at the top then lower slowly. Repeat with the other arm. Bench dips (for triceps): Sit on the side edge of a flat bench or the front edge of a chair. Place your hands on the edge of the chair right beside your glutes and grip the edge. Your feet should be flat on the floor (about 2 ft in front of your bent knees). Move yourself off the chair so you are now supporting yourself on your hands. Bend your arms, dipping your body down. Go down only as far as you feel comfortable. Push back up and squeeze the triceps. It is important to keep your back close to the edge of the bench as you do this to minimise shoulder stress. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net Featured in Harmony Magazine October 2010

Easy-to-do Get motivated to exercise Every time I embark on an exercise programme, I quit in three to four days. I am in my 60s and have always led a fairly sedentary life. Please suggest some easy exercises that I can do without losing interest and motivation. We are motivated to do things we benefit from. For instance, if I told you I would give you a million dollars to take a 30-minute walk tomorrow, would you do it? I bet you would! The benefits of exercise aren't quite that compelling, but they are pretty motivating. Create your personal list of reasons. Keep a piece of paper and pen handy for a couple of days. Write down every reason for getting fit/losing weight—for instance, one could need "more energy to spend time with your family". Exercise with a friend. Statistics tell us that people who exercise with a friend exercise more consistently. Train for a local 5K to 10K walk in your area. I've seen many people transformed from couch potatoes to lean, mean exercise machines because they decided to enter and train for a competition like this. Reward yourself. Put aside a small amount of money—say Rs 30—every time you exercise. After a month, see how much you've saved and splurge on something you normally wouldn't buy for yourself. Keep records. Write down your exercise time (in minutes) each day. Keep a running total for the month and year. Calculate your average exercise time per day. Set lofty goals. EASY EXERCISES Here are some simple exercises you can start with. Cardiovascular exercises: Walking is the simplest, cheapest and easiest form of cardiovascular exercise. It is very low impact and extremely convenient. Start slowly, then gradually work up to walking longer and faster. Finding a walking partner can help keep you motivated. Jogging/running is a step up from walking. It is harder and puts more impact and stress on the body. If you are just starting an exercise programme, work through fast walking before moving up to jogging. You could cycle as well as swim. Resistance exercises Wall push-ups: Stand facing a wall with your feet 1-2 ft away from it. Place your hands on the wall; keep them a shoulder width apart. Bending only at the elbows, lower yourself forward towards the wall then push yourself away from it. Keep your body stiff and straight during the movement. Standing rows for the back: These are done from a standing position. Loop a towel around a vertical pole, column or another fixed object; the end of the towel should be wrapped around the far side of the pole. Bring your feet close up to the pole and lean back gripping the ends of the towel and keep your body stiff and straight. Row yourself up with both arms. Keep the back arched and row with your back. Seated dumbbell presses for shoulders: Use something around the house as weights—soup cans or plastic bottles with water in them. From a seated or standing position, hold the weights just above your shoulders. Push them up overhead slowly. Next month, I will talk about easy-to-do resistance exercises like bodyweight squats, abdominal crunches and workout for arms and calves. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net Featured in Harmony Magazine September 2010

Joint control Regular exercise keeps joints fluid I am 62 years old and have been exercising regularly since 2007. However, in 2009, I was diagnosed with rheumatoid arthritis and prescribed medication. This has helped improve my mobility to a great extent. I would like to avoid surgery in future. Are there any specific exercises that will help strengthen my joints? Regular exercise is one of the best favours you could do your joints. In fact, the benefits are manifold: It can reduce overall pain from rheumatoid arthritis. Thinning of the bones can be a problem with rheumatoid arthritis, especially if you need to take steroids. Exercise helps bones maintain their strength. It maintains muscle strength. It improves functional ability and allows you to do more for yourself. Certain exercises have been proven to be safe for people with rheumatoid arthritis. You could follow a regimen comprising stretching, strengthening, conditioning and a range of motion exercises. Stretching is the simplest and easiest. It consists of stretching and holding different joint and muscle groups for 10 to 30 seconds each. Stretching improves flexibility, and daily stretching is the basis for any exercise programme. Strength exercises involve working the muscles against resistance. This can be either with or without weights. Resistance training strengthens muscles and increases the amount of activity you can do without pain. Conditioning, also called aerobic exercises, improves cardiovascular fitness. There are countless benefits of aerobic exercises. Some of them include making your heart and blood vessels healthier, preventing disability and improving mood and well-being. Good conditioning for those suffering from rheumatoid arthritis includes low-impact activities like walking, swimming, bicycling or using an elliptical machine. Any of these activities will get your heart pumping. Range of motion exercises is one part of a comprehensive rheumatoid arthritis exercise regimen. Range of motion exercise programme 1. Gently squeeze your fingers to make a fist; then stretch your fingers open and apart. 2. Rotate your wrists clockwise; then counter clockwise. 3. Bend and straighten your elbows. 4. Sitting with your forearms resting on your lap or table, palms facing up, turn the palms down, rotating at the elbow; then turn the palms up. 5. While sitting, straighten and bend your knees. 6. Flex and point your ankle. 7. Draw the alphabet with your foot. 8. Pendulum range of motion: Standing, hold on to the back of a chair with your right hand and bend over so that you are facing the floor. Allow your left arm to dangle straight down. Gently draw circles clockwise then counter clockwise, beginning with small circles and gradually drawing larger ones. Exercises to avoid Avoid exercises that require you to put a lot of stress on a joint, or are 'high-impact'. These include: Jogging, especially on paved roads Heavy weight lifting Avoid doing exercise when the joints are stiff and painful. Dietary suggestions for rheumatoid arthritis Omega-3 fatty acids play an important role in controlling inflammation of the joints. Some foods that are rich in omega-3 fatty acids include: Fatty fish such as salmon, mackerel and herring Fish oil such as cod liver Soybeans and soybean oil Walnuts and walnut oil Regular exercise together with a proper diet can help us cope with rheumatoid arthritis more effectively. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities Website: www.talwalkars.net Featured in Harmony Magazine August 2010

Weight management In his new column, Madhukar Talwalkar offers advice on exercise and diet I used to work out regularly — run, weight-train and perform cardio exercises every alternate day. I am now in my mid-50s and finding it increasingly difficult to maintain my weight. What can I do? It's easier to gain weight than lose it. As we age, it also seems to take twice as long to lose a few kilos. Being a woman over the age of 50, you may wonder if there are any easy ways to lose weight without burning yourself out. At any age, diet and exercise are the best. However, there are specific ways of eating and exercising that can help you reap maximum benefits. I have suggested some tips below that will help you jumpstart the weight loss programme. Please get a 'go ahead' from your doctor before you start the new regimen. Then, keep a watch on your weight and body measurements. Tip 1: Eating for weight loss Though you may feel that you eat relatively healthy, it is still important to know what foods can slow your progress and keep you overweight. These include refined sugar, processed foods, and simple carbohydrates. You should avoid or significantly go slow on foods such as white bread, rice, pasta, cereal and baked goods (cake, cookies, pies). The easiest way to make healthy eating simple is to purchase food that is as close to its natural state as possible. Think fresh when buying vegetables, fruit, and meat. Food in packages is typically highly processed and full of sugar. Eat according to portions, not calories. Each time you take a serving, eat by measurements of fist and palm size. By eating well at least 80 per cent of the time, you won't need to stress yourself out with calorie counts or weighing food. Proteins, carbohydrates and vegetables are very essential in your meal. Eat less at a time but frequently — between four and six meals per day. Vegetables should be included at least twice with your meals. Water is a very essential component; you should have at least eight to 10 glasses a day. Tip 2: Exercising to burn fat It is good that you were into weight training. If you restart resistance training again, it will be easy to get results as they are some of the best exercises to burn fat. Make an effort to lift free weights — they should be comfortable and challenging at the same time. The more muscle you have, the more fat you can burn as well as calories. One kilo of muscle burns more calories than 1 kg of fat. Muscles burn calories even at rest. Free weights are a much better option and usually a set of dumbbells will be more than enough. You don't have to spend hours doing cardio. If you enjoy long cardio sessions, you can still continue to do them between strength training exercises. ESTABLISH YOUR FITNESS GOALS The intensity and schedule of weight training for people over the age of 50 should be based on very personal, specific and fundamental goals. Two to three days resistance training (20 to 40 minutes), two to three days cardio (20 to 40 minutes); preferably cardio and resistance training on alternate days Variations in exercise are very important for better weight loss Balanced diet Supplementing diet with multivitamins and calcium will aid weight loss Consistency in all suggestions mentioned above will give better results. There is a lot of scientific evidence that suggests that we can slow down and even reverse the symptoms of ageing. In fact, many of us can be in better health in our 70s than we were in our 50s. Regular exercise can improve heart and respiratory function; lower blood pressure; increase strength; improve bone density; improve flexibility; quicken reaction time; reduce body fat; increase muscle mass; and reduce susceptibility to depression and disease. Madhukar Talwalkar is chairman of Talwalkar's, one of India's largest chain of fitness centres with 78 branches across major cities. Website: www.talwalkars.net Featured in Harmony Magazine July 2010