February 2020 – Cardiac Wellness Institute

At our centre, we regularly come across individuals with multiple health problems, particularly those related to heart disease. Very often, they need robust prevention and rehabilitation programs to help improve their physical, physiological and psychosocial wellbeing.

One such condition which we encounter commonly these days is “Metabolic Syndrome”. As the name suggests it is a combination of multiple risk factors of heart disease such as abdominal obesity, high blood pressure, increased blood sugar level and abnormal cholesterol level. This condition is growing in number day by day in India and expected to grow exponentially across the globe. The fact that several risk factors are present in the same individuals puts them at a very high risk of heart attack and stroke.

Based on multiple research findings, the rise in the incidence of obesity and diabetes was found to be the main reason behind the increase in metabolic syndrome. Also, the younger population, that is individuals between 25 and 35 years of age, are most affected suggesting that it is high time the youngsters take note of it!

The criteria for diagnosing Metabolic Syndrome as per the International Diabetes Federation guidelines in 2006 are:

Higher waist circumference – more than 102cm for men; more than 88 cm for women & higher BMI
Increased blood sugar level – more than 100 mg/dL
Abnormal cholesterol levels – increased triglycerides and decreased High-Density Lipoprotein
Increased blood pressure – more than 130/85 mmHg

The unhealthy lifestyle choices of our people such as

Physical inactivity
Unhealthy diet
Chronic stress
Disturbed sleep pattern
Increase in tobacco and alcohol consumption

are the culprits causing this sudden surge in metabolic syndrome.

One important fact to be highlighted here is that all the above risk factors are interrelated which means that the occurrence of any one of the risk factors could pave way for the others as well.

If an individual has been diagnosed with metabolic syndrome, the following management should be initiated at the earliest:

1. Intensive lifestyle modification

An intensive lifestyle modification program is the first and only step in fighting metabolic syndrome, especially in individuals who are young, whose blood pressure, blood sugar and cholesterol levels are borderline elevated and who are free of organ damage. The program typically consists of health education about the condition and its effect on the body, tailor-made exercise training which focuses on controlling blood pressure, lowering blood sugar and cholesterol levels and education about the importance of exercise, along with personalized dietary guidance. Psychosocial counselling to help individuals cope better with their mental stress and emotional problems is also included in the program.

Importance of Exercise Training in Metabolic Syndrome

Exercise training is the cornerstone in the lifestyle program because of its multiple benefits:

Aerobic Training

Helps to improve endurance and stamina
Results in fat and carbs being used up as calories
Lowers blood sugar, normalises cholesterol level and also controls blood pressure
Aids in weight loss

If you are wondering how much aerobic exercise is adequate, here is my recommendation:

Frequency	Intensity	Duration	Type
5-7 days/week	Mild to moderate Intensity	30-60 minutes/day	walking, jogging, cycling, swimming, hiking, treadmill, EFX

Strength Training

Helps to improve muscle strength and power
Aids in calorie expenditure and weight loss
Increases muscle mass and reduces fat mass
Can be done with the help of equipment or use of bodyweight too

Guidelines for strength training:

Frequency	Intensity	Duration	Type
2-3 days/week	Mild to moderate Intensity	20-30 minutes/day	Bodyweight (push-ups, pull-ups, squats), dumbbells, barbells, machine-based

Other types of exercise training such as flexibility training, interval training and circuit training can be incorporated in the exercise program as per the individuals’ needs and health goals.

2. Medications

In individuals with advanced metabolic syndrome, that is high levels of blood sugar, abnormal cholesterol and uncontrolled blood pressure, medications such as anti-diabetic drugs, anti-hypertensive drugs and cholesterol-lowering drugs should be initiated along with the lifestyle intervention.

3. Surgery

Fat-reduction surgery or bariatric surgery is sometimes needed to address severe obesity especially if it does not respond to lifestyle changes and medications.

As metabolic syndrome is on the rise and so is the incidence of heart attack and stroke, we need to adopt a healthy lifestyle that includes regular exercise, balanced diet, well-managed stress and adequate sleep, along with regular medical checks. It is never too early and never too late to make a change that will improve your health and your overall wellbeing.

If you are someone who sits for long hours, either for work or for leisure, this is a must read for you. Recent studies have shown that sitting at a desk, in front of a television, on the couch etc. for extended periods of time is associated with increased risk of hypertension, diabetes, obesity, cancer and heart disease.

But why is sitting compared with smoking? We all know that smoking is extremely harmful, to the extent that each cigarette is considered as lethal as a bullet. Is sitting also that sinister? Let’s look at some recent trends to better understand sitting and it’s harmful effects and changes we can adopt to minimize the harm.

Work trends

A majority of the youngsters today are working in environments that require long hours of sitting. Computer professionals, bank employees, public service cadres, teachers, medical professionals, call-centre agents, drivers, the list goes on. Number of hours of sitting ranges from 4-8 hours per day for most of them which adds up to almost 30-40 hours of sitting a week. And in their non-working hours, they choose to sit some more to watch television, surf the Internet and socialize over drinks and dinner.

In fact, the risk of heart attack and stroke is much higher in Indians in their 20s and 30s as compared to the western population where it is still a disease of the older age group. A combination of unhealthy lifestyle choices and genetic predisposition underlies this health hazard and prolonged sitting or physical inactivity or less movement is definitely a contributor.

One of the popular solutions has been standing workstations where you stand and work instead of sitting and working. However, standing for long periods of time also has its disadvantages and can lead to varicose veins, foot pain etc. Hence a combination of sit/stand work environment with adequate movement every 30 minutes is what we should aim for. Walking meetings are a welcome trend for small group meetings, phone discussions and conference calls.

Workstation exercises are a set of exercises that individuals do in their work spots every few hours for a duration of 10-15 minutes to relieve the stress of working and to refresh the body and mind. We, at Cardiac Wellness Institute, take pride in providing tailored workplace health and wellness interventions for organizations.

Fitness focus

You would agree with me in my observation that Indians tend to associate movement, activity, exercise, sports and fitness with their growing-up years and then put a full stop to it. As we enter into adulthood, into work routines and start a family of our own, we become less interested in and less motivated to pursue our passion for sports or active hobbies and blame it on the lack of time.

While it is challenging to juggle responsibilities like kids, work, social demands and personal wants, it is not impossible to be active throughout the day. All seated activities should be limited to short bouts of 30 minutes or so and interspersed with stretches, minor exercises and walking breaks as permitted by the work you are engaged in.

A sustainable way to incorporate fitness in the workplace is to form activity groups or clubs and work together as a unit. Running clubs, bicycling events and swim teams are some examples of likeminded individuals pursuing active hobbies in the workplace and this is a welcome change in organizations these days.

Healthy Ageing

As we age, we need to be more active both physically and mentally to counter the slowing metabolism, weakening of bones, the psychological setback of old-age and the neurodegenerative conditions like dementia and memory loss. Sitting should not be the default posture in our retired days, instead it should be a few minutes of sitting in between household chores, outdoor activities and active hobbies.

In case you are forced to sit for long hours due to mobility issues or joint pain, it is advisable to keep moving the neck, torso, upper limbs and lower limbs at frequent intervals to improve circulation, prevent muscle wasting and strengthen muscles.

In conclusion, smoking has devastating effects on our health and is to be completely and totally avoided. Sitting however is not so dangerous for us but the associated lack of exercise leading to heart attack and other chronic ailments is the bigger health concern facing humanity today. As a strong proponent of mindfulness, I would recommend mindful sitting which simply means being aware of our seated posture and sitting straight, doing some exercises while sitting and grabbing any opportunity to break that long sit.

Sit less, move more and live a healthy life!