Dr.Maninder Ahuja

PRESENT DESIGNATION:DIRECTOR AHUJA HOSPITAL AND INFERTILITY CENTRE FARIDABADON PANEL WITH AIMS, METRO AND SARVODAYA HOSPITALS

PRESENT AFFILIATION:PRESIDENT INDIAN MENOPAUSE SOCIETY DEPUTY SECRETARY GENERAL OF SOUTH ASIAN FEDERATION OF MENOPAUSE SOCIETIES

MAJOR ACHIEVEMENTS:

(HONOURS)(AWARDS)(PUBLICATIONS)EDITOR OF BOOK PREMALIGNANT LESIONSOF CERVIX-EARLY DIAGNOSIS AND MANAGEMENTAUTHOR OF BOOK STEP BY STEP MANAGEMENTOF MENOPAUSESEVERAL CHAPTERS IN TEXT BOOKS LIKE JEFFCOATE, OPERATIVE OBSTETRICS AND GYNECOLOGY FOR POST GRADUATES,PRINCIPLES AND PRACTICE OF OBST, AND GYNECOLOGY, MANY DVDS ON PRESCRIPTION OF EXERCISEBEST FOGSIAN AWARD 2008, BEST PRESENTATION AWARD, BEST ROTARIAN AWARD

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AGRAAHEMDABADBANGALOREBHARUCHCHANDIGARHCUTTACKCHENNAIDELHIFARIDABADGURGAONHYDERABADINDOREJALANDHARJAIPURJAMMUKOLKATALUCKNOWMUMBAINAGPURNAVI MUMBAIPUNERAIPURRAJKOTSURATVARANASIGWALIORLUDHIANAJODHPURUDAIPURCALICUTPATIALAAJMERALLAHABADJABALPURGUWAHATIBHOPALBIKANERSHIMLACurrent IMS Chapters40 IMS Chapters all over India

How to slow down the hands of time?Control weight gain and exercise

Dr.Maninder AhujaDirector Ahuja Hospital &Infertility Centre setor 17 FBD

WOMAN IS THE PIVOT OF UNIVERSE!Woman is the axle around whom the family, society nay! The whole universe is revolving .So her health is of utmost importance at all stages of life more so in Menopause.

*Dr.Maninder ahuja*

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Health issues Why important?Life expectancy is increasing!!!Remember - in 1900 people were considered old in their 40s; just 40 years ago people seemed old in their 60s; but today many do not feel old in their 80s a phenomenon and we say never feel old and remain walking till the final recall!From 30 yrs to 76 years

*Dr.Maninder ahuja*

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POPULATION PYRAMIDS

QUALITY OF LIFE IS IMPORTANTIn these Golden Years

she wants to have her own identity!

*Dr.Maninder ahuja*AAJ PHIR JEENE KI TAMMANNA HAI , AAJ KUCH KARNE KA IRADA HAI!!!!!!!

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

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*Dr.Maninder ahuja*FIT AT FORTY STRONG AT SIXTY AND INDEPENDENT AT EIGHTY !!

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Physical Problems Slowing us downVaso motor symptomsHot flushesMood changesSleep disordersMusculo SkeletalSarcopeniaOsteoporosisJoint aches and painsOsteoarthritisUGS- itching vagina, dysparunia

Metabolic syndromeCardiac problemsHypertensionObesityCardiorespiratory

Long term Longevity CancersAlzheimer

FACT SHEETWorldwide obesity has more than doubled since 1980.65% of the world's population live in countries where overweight and obesity kills more people than underweight.More than 40 million children under the age of five were overweight in 2010.

Obesity is preventable.

In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.*

CHANGING TIMES

Which one is Quality life?*Dr.Maninder ahuja*

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Purpose of presentationSensitization about QOL IssuesDifferent life style modifications Different types of exercisesIntensity of exerciseDuration of exerciseFrequency of exerciseDifferent types of diet.Carry home message

*Dr.Maninder ahuja*A small truth to make life 100%and enjoyable!A SMALL TRUTH TO MAKE LIFE 100% What makes life 100%

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*Dr.Maninder ahuja*

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*Dr.Maninder ahuja*Hard Work H+A+R+D+W+O+R+K8+1+18+4+23+15+18+11 = 98%KnowledgeK+N+O+W+L+E+D+G+E 11+14+15+23+12+5+4+7+5 = 96%

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*Dr.Maninder ahuja*LoveL+O+V+E12+15+22+5 = 54%LuckL+U+C+K12+21+3+11 = 47% ( don't most of us think this is the most important ??? )

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*Dr.Maninder ahuja*Then what makes 100% ?Is it Money ? ... NO ! ! !M+O+N+E+Y13+15+14+5+25 = 72%Leadership ? ... NO ! ! !L+E+A+D+E+R+S+H+I+P 12+5+1+4+5+18+19+9+16 = 89%

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*Dr.Maninder ahuja*

ATTITUDE A+T+T+I+T+U+D+E 1+20+20+9+20+21+4+5 = 100%It is OUR ATTITUDE towards Life and Work that makes OUR Life 100% ! ! !

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Keep laughing !

Throw out all non essentialNumbersThat includes Age

What number you should be careful about is your weight and WHR

So to slow down hands of timeWe have to change our attitude !B +

Cherish your health:Your firstTemple is your Body!

If it is good, preserve it. If it is unstable, improve it. If it is beyond what you can improve, get HELP !

The rise of non communicable diseases in India

Harmful effects of obesityIncreased risk ofHeart disease,High blood pressureDiabetesCancer of uterus, cervix and breast cancer and some other cancersOsteoarthritis

Recovery poor after surgeries and cancer treatmentSleep apnea and sleep problemsQOL Logevity decreasedPoor body imageDepression

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Causes of obesity Can be continous from adolescents Around perimenopause

What worries you most ?External appearance ?

Over all fitness?

Both ?

Deepak tale andhera people know me in pakistan, they know me in srilanka, but here in Delhi I was wondering *

SYNCHRONIZATION OF FACE AND BODY

External appearanceCan be arranged by spending money but for a limited time only.

Cosmetic surgeries

Laser

Botox

Collagen fillers basket full !

What is happening?Obesity (BMI)in adult women rises significantly each decade, until it begins tapering off late in life in seventies.on average gain 2.5kg.

Increased central adiposity during menopause

Fat increases &lean muscle mass decreases 30% to 40% relative to total body mass as we age.

Altreration in waist hip ratio

Decrease in BMD,peak till 35 yrs.

5-05-2007Dr.maninder ahuja

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The perimenopause and body composition A more rapid increase in fat mass Redistribution of fat to the abdomen Transition from a gyncoid to an android pattern of fat distribution and an increase in total body fat and increased risk of Metabolic syndrome

**drmaninder ahuja NARCHI

SARCOPENIA-what you cant seeGOOD LEAN MASSSARCOPENIA5-05-2007Dr.maninder ahuja

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Leisure time increases

Ideal weight and WHRFor asians For othersBMI of 18-23normal. (20-25 )BMI of 23-28 is overweight (25-30)BMI of over 28 is obesity (>30)BMI of over 35 is morbid obesityBMI is Wt.in Kg /ht in sqM

Ideal WHR(waist hip ratio) 0.8(1 for men)

5-05-2007Dr.maninder ahuja

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*drmaninder ahuja NARCHI*

BMI CALCULATING CHARTS

WEIGHT CONTROL BY CALORIE RESTRICTIONCaloric restriction, the centerpiece of weight-loss efforts for most women, decreased BMR and loss of fat free mass.

Because the resting metabolic rate accounts for nearly two thirds of total caloric expenditure and muscle mass accounts for 20%of REE

5-05-2007Dr.maninder ahujaNO!!!

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Weight loss

Is it a losing battle?

*Dr.Maninder ahuja*

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MOTIVATION!

*Dr.Maninder ahuja*

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

Three types of dietsAfter losing 10% to 15% of body weight during a run-in phase, participants were allocated to a low-fat diet (20% fat, 60% carbohydrate, 20% protein), a low-glycemic-index diet, and a very low-carbohydrate diet (10% carbohydrate, 60% fat, 30% protein) in random order, each for four weeks. The primary outcome was resting energy expenditure with secondary outcomes of total energy expenditure, hormone levels, and metabolic syndrome components.

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

RESTING ENERGY EXPENDITUREThe reduction in resting energy expenditure was greatest with the low-fat diet, intermediate with the low-glycemic-index one, and least with the low-carb diet. The decrease in total energy expenditure showed a similar pattern

Effects of energy expenditureThose on the low-carb diet burned 350 calories per day more than those on the low-fat one, even though they consumed the same amount of calories on all these diets. That's equivalent to one hour of moderate-intensity physical exercise And those on the low-glycemic-index diet lost about 150 calories per day more than those on the low-fat one, "equal to about an hour of light physical activity,(

Neither total physical activity nor time spent in moderate- to vigorous-intensity physical activity differed among the diets.)*

Strongest support for concept that not all calories are the same

Low-carb diet : increases in CRP, a measure of chronic inflammation, and 24-hour cortisol, the key stress hormone, "suggesting that any initial advantages were eroded over time by these biological stressors,Low-fat diet :as well as resulting in the least energy expenditure"exacerbated many of the components of the metabolic syndrome, so insulin resistance, triglycerides, and HDL cholesterol were all worse on this diet,

LOW GYLCEMIC INDEX DIET IS BEST

Diets

SUGARS??????

Smoking is bad !!

Dynamic Duo !

Role of Vit D Serum 25 D should be 80 nmol/L or higher

Low levels of vitamin D are highly prevalent Vitamin D plays a key role in normalizing PTH levels

Vitamin D deficiency is associated with increased risk of falls and fractures,

vitamin D intakes much higher than are currently recommended are quite safe.

Raising serum 25(OH)D from 50 to ~80 nmol/L improves Ca absorption, raises BMD, and reduces both fall and fracture risk

*Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI*

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Vit D Def & Risk Of Falls*Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI*

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Role of calcium 1200-1500 mg/day and Vit 800 IU is undisputed,low salt,low sugar and fat and low High GI Carbs but high fibre

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

Recommendations for total activityAll healthy adults aged 18-65 years should aim to take part in at least 150 min of moderate-intensity aerobic activity each weekor at least 75 min of vigorous-intensity aerobic activity per week, or equivalent combinations of moderate- and vigorous-intensity activities. Muscle training two or three times a week

All healthy adults should also perform muscle-strengthening activities on two or more days a week. Weight training, circuit classes, yoga, and other muscle-strengthening activities offer additional health benefits and may help older adults to maintain physical independence*

Beginners Beginners should work steadily towards meeting the physical activity levels recommended for all healthy adults like increasing 10 min of activity every other day for several weeksThey should enjoy

Even small increases in activity will bring some health benefits in the early stages and it is important to set achievable goals that provide success, build confidence, and increase motivation. For example, a beginner might be asked to walk an extra 10 min every other day for several weeks to slowly reach the recommended levels of activity for all healthy adults. It is also critical that beginners find activities they enjoy and gain support in becoming more active from family and friends. *

Conditioned individualsConditioned individuals who have met the physical activity levels recommended for all healthy adults for at least 6 months may obtain additional health benefits by engaging in 300 min or more of moderate-intensity aerobic activity per week, 150 min or more of vigorous-intensity aerobic activity each week, or equivalent combinations of moderate- and vigorous-intensity aerobic activities.Those who want to lose weight or like diabetes should go beyond health goals for adults along with calorie restriction

Adults who find it difficult to maintain a normal weight and adults with increased risk of cardiovascular disease or type 2 diabetes may in particular benefit from going beyond the levels of activity recommended for all healthy adults and gradually progressing towards meeting the recommendations for conditioned individuals. Physical activity is beneficial to health with or without weight loss, but adults who find it difficult to maintain a normal weight should probably be encouraged to reduce energy intake and minimize time spent in sedentary behaviours to prevent further weight gain. Children and young people aged 5-16 years should accumulate at least 60 min of moderate-to-vigorous-intensity aerobic activity per day, including vigorous-intensity aerobic activities that improve bone density and muscle strength.*

When to start Those who start early have better physical performanceUsing data on approximately 2400 men and women from the UK Medical Research Council National Survey of Health and Development, followed up since birth in March 1946, the associations of physical activity levels during leisure time self-reported prospectively at ages 36, 43, and 53 years with grip strength, standing balance, and chair rise times, assessed by nurses at age 53 years (in 1999), were examined in 2010.

British birth cohort. Am J Prev Med 2011;41:376-84.

Weight gain in midlifeless if started earlyOur bodys metabolism slows as we age, but moderate to vigorous exercise can counteract this decline by lessening weight gain. Those who begin moderate to vigorous physical activity in their 20s and continue through middle age gain less weight. Women particularly benefited from 20 years of high activity, gaining on average 13 pounds less than those with low activity, says the study.

Our bodys metabolism slows as we age, but moderate to vigorous exercise can counteract this decline by lessening weight gain. According to a study published December 14 in JAMA, people who begin moderate to vigorous physical activity in their 20s and continue through middle age gain less weight. *

BANKING OF GOOD HEALTH HAS TO START FROM ADOLELSCENCE

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

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Structured daily routine activities*drmaninder ahuja NARCHI*

Fat loss is all about long-term goalsHOW LONG EXERCISE?

It takes 20 minutes for an unconditioned person to actually start burning fat. An average conditioned person will take about 10 minutes Aim is 45 min/dayIt takes a fit person about 11 sessions of a 45-minute fat-burning exercise period to burn 1lb of fat, which is 3,500kcal.

*Dr.Maninder ahuja*

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Despite all these if you have

Weight lifting is good !

Components of fitnessExercise is designed to improve the five key components of physical fitness: Cardio-respiratory endurance, Muscle strength and loss of bone massmuscle endurance, Flexibility and stretching exercises are like yoga, taichi Body composition.

*Dr.Maninder ahuja*

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Types of exercises

Aerobic like walking, swimming, cycling, dancing, taichi, yoga for burning fat Range of motion or Stretching exercises like Pilatees,yogaWeight training & resistive exercises build up the muscles and tendons that support your jointsMindful exercises like meditation

*Dr.Maninder ahuja*

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Stretching exercises

Exercises Stretching exercisesResistance and weight bearing

16.bin

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Strength training in osteoarthritisAFTER 12 WEEK ST TRAINING PROGRAMMEBalance improved55 %Muscle strength increased 14 % Flexibility improved 17%Self-reported pain decreased 30%Tibial cartilage volume increased. 2007 Current Medicine Group Ltd, a part of Springer Science+Business Media

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You need stamina for walking!*Dr.Maninder ahuja*

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INTENSITY OF EXERCISEModerate to severe in intensity How to know about intensityMHR : 60-80 % of MHR and MHR is 220 _ age in yrs. At 50 yrs 220-50 = 170 and 60 % is 102-136 Borg test of SPE Talk test

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MENOPAUSE AND EXERCISEMenopausal status does not appear to lower a woman's ability to favorably alter her body composition and cardiorespiratory endurance through aerobic conditioningExercise is particularly helpful for middle-aged women who want to control their weight because it reverses the diet-induced reduction in metabolic rate and also increases fat-free mass. In fact, physical activity of sufficient magnitude can largely offset age-related changes in body composition. A cross-sectional study of female athletes and sedentary women, aged 18 to 69, found no difference in body fat percentage and fat-free mass between the youngest and oldest athletes. In addition, the resting metabolic rate of the older exercisers was closer to that of the young athletes than to that of sedentary, age-matched women.

(11) Cowan MM, Gregory LW: Responses of pre-and post-menopausal females to aerobic conditioning. Med Sci Sports Exerc 17(1):138-143, 1985. Ryan AS, Nicklas BJ, Elahi D: A cross-sectional study on body composition and energy expenditure in women athletes during aging. Am J Physiol 1996;271(5):E916-E921Fiatarone MA, Effects on skeletal muscle. JAMA. 1990; 263:3029-34

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SOME GUIDELINES

Learn proper way of stair climbingSplit it up ,use pedometre

U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf

DANCING IS BEST AEROBIC EXERCISE

What are resistance and wt training exercisesTo build up your strength and staminaTo increase your BMDTo prevent and REVERSE sarcopeniaMood elevationIncreased libidoLess cancersAfter cancers QOL Better

Integrated into your life style!

AS A LAST RESORT !!

If you want to be free and flying!&make the journey of life beautiful!Come and exercise ,change attitude ,eat properly!!!!You don,t have to lose anything except your fat!

*Dr.Maninder ahuja*

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Tell the people you love that you love them, at every opportunity. Life is not measured by the number of breaths we take, but by the moments that take our breath away

Be together and keep dancing!

Don,t be left behind!Turn back the clock !!!!! , , , , *Dr.Maninder ahuja*

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*In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.**

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*Deepak tale andhera people know me in pakistan, they know me in srilanka, but here in Delhi I was wondering *

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All calories are not sameExtreme restriction of fat or carbs can have bad effects. The best long-term approach will be to avoid restriction of any major nutrienteither fat or carbohydrateand instead focus on the quality of nutrients. This is not to say that the number of calories isn't important, but it's now saying we should also pay attention to the quality of those calories. So the argument that the food industry likes to makethat all foods can be part of a healthful diet as long as you watch caloriesis really misleading at best.*Neither total physical activity nor time spent in moderate- to vigorous-intensity physical activity differed among the diets.)*

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*All healthy adults should also perform muscle-strengthening activities on two or more days a week. Weight training, circuit classes, yoga, and other muscle-strengthening activities offer additional health benefits and may help older adults to maintain physical independence*Even small increases in activity will bring some health benefits in the early stages and it is important to set achievable goals that provide success, build confidence, and increase motivation. For example, a beginner might be asked to walk an extra 10 min every other day for several weeks to slowly reach the recommended levels of activity for all healthy adults. It is also critical that beginners find activities they enjoy and gain support in becoming more active from family and friends. *Adults who find it difficult to maintain a normal weight and adults with increased risk of cardiovascular disease or type 2 diabetes may in particular benefit from going beyond the levels of activity recommended for all healthy adults and gradually progressing towards meeting the recommendations for conditioned individuals. Physical activity is beneficial to health with or without weight loss, but adults who find it difficult to maintain a normal weight should probably be encouraged to reduce energy intake and minimize time spent in sedentary behaviours to prevent further weight gain. Children and young people aged 5-16 years should accumulate at least 60 min of moderate-to-vigorous-intensity aerobic activity per day, including vigorous-intensity aerobic activities that improve bone density and muscle strength.*Our bodys metabolism slows as we age, but moderate to vigorous exercise can counteract this decline by lessening weight gain. According to a study published December 14 in JAMA, people who begin moderate to vigorous physical activity in their 20s and continue through middle age gain less weight. *

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