BMI Singapore context

Excerpt from the Health Promotion Board, Singapore on the revised BMI scale for Singapore dated 16 March 2005

REVISION OF BODY MASS INDEX (BMI) CUT-OFFS IN SINGAPORE

1. The BMI cut-off levels for Singapore will be revised based on the findings from local studies and the recommendations from the WHO Expert Consultation in Singapore.

2. Recent studies have shown that many Asian populations, including Singaporeans, have higher proportion of body fat compared to Caucasians of the same age, gender and BMI.

3. These studies also showed that Asians have increased risk for cardiovascular diseases and diabetes mellitus at relatively low BMI levels. In Singapore, about half of adult Singaporeans with BMI of 22 to 24 kg/m2 have at least one cardiovascular risk factor.

4. WHO convened an expert consultation to review the BMI cut offs to define risks in Asian populations and recommended that for some Asians, BMI of 23 kg/m2 or higher marks a moderate increase in risk while a BMI of 27.5 kg/m2 or more represents high risk.

5. In view of this, MOH and HPB have recommended that the BMI cut-off points for public health action and clinical interventions proposed by the WHO expert consultation for adults be adopted. The recommended BMI cut-offs are:

Singapore Scale	Category	American Scale
less than 18.5	Underweight Risk of nutritional deficenty and osteoporosis	less than 18.5
18.5 - 22.9	Healthy Range; Low Risk	18.5 - 24.9
23.0 - 27.4	Overweight; Moderate Risk	25.0 - 29.9
27.5 and above	Obese; High Risk	30.0 and above

6. For the purposes of public health action, the new BMI cut offs will be used at the national level for planning of programmes to prevent obesity and other obesity-related diseases. For the individual and for clinical intervention, these BMI cut-offs should be triggers and indicators that warrant further clinical investigations for risk factors and follow-up interventions and for the individuals to make changes to their lifestyles to adopt healthy lifestyle practices. For someone with a BMI within the moderate or high risk group, losing 5-15% of one’s body weight can improve one’s general health.

7. With the adoption of the new BMI cut-offs for public health action in Singapore, the distribution of the adult population aged 18 to 69 years, by BMI risk categories are 9% of adults with a BMI less than 18.5kg/m2, 42% of adults with BMI between 18.5kg/m2 and 23kg/m2, 35% of adults with BMI between 23kg/m2 and 27.5kg/m2, and 14% of adults with BMI more than 27.5kg/m2.

Recommendations of the Taskforce for Obesity Prevention and Control

8. With the global rise in obesity and the rising trend of overweight and obesity in Singapore adults from 26% in 1992 to 30% in 1998, HPB convened a Taskforce on Obesity Prevention and Control. Please refer to Annex 1 for the Terms of Reference of the Taskforce.

9. The multi-sectoral Taskforce was formed in February 2004, chaired by Dr Lam Sian Lian, Chief Executive Officer, Health Promotion Board, and comprised representatives from the Ministries of Health, Education, National Development, Community Youth and Sports, as well as the Singapore Armed Forces, Agri-Food & Veterinary Authority, National Parks Board, together with healthcare professionals from the College of Family Physicians, Singapore Nutrition and Dietetics Association, The Children Medical Institute, and other experts in the field of obesity. Please refer to the Annex 1 for the list of the Taskforce members.

10. The Taskforce proposed a co-ordinated framework to address the prevention and control of obesity in Singapore.

11. The framework encompasses multi-disciplinary strategies and programmes in 4 key settings: the Community, Workplaces, Schools and Preschools, and Healthcare. Please refer to the Annex 2 for more information on the programmes.

12. Underpinning the strategic framework are the following recommendations:
a) Consistent messages : Guidelines for BMI cut-offs, regular physical activity and healthy diet should be used consistently across all government and professional agencies in public messages.
b) Emphasis on health risks rather than weight: In communications about obesity and overweight, the health risks associated with obesity and overweight should be stressed rather than weight, to emphasise that overweight and obesity are about health risks rather than looks and aesthetics.
c) Emphasis on the importance of individual responsibility: Achieving and maintaining a healthy weight is a matter of individual responsibility to make the necessary lifestyle choices. Knowledge and skills will continue to be imparted to Singaporeans through the various channels such as the National Healthy Lifestyle Campaign, exhibitions, talks and education curriculum.
d) Provision of an environment supportive of health to enable Singaporeans to adopt a healthy lifestyle: The Taskforce recognised the importance of providing an environment that is supportive of a healthy lifestyle and proposed various strategies and programmes in the 4 key settings. Proposals included:
i) Make resources, opportunities and facilities available for increasing physical activity;
ii) Ensure that healthier food choices, such as fruit, vegetables and low fat high fibre products remain available and affordable;
iii) Adopt healthy eating guidelines in settings where food is served regularly, such as in workplaces, military camps, schools and preschools;
iv) Promote health in the workplace, engaging management and employees to accept and actively participate in a healthy lifestyle at work;
v) Provide parents, teachers and tuckshop vendors with the training and the resources to create supportive environments for healthy eating in homes, schools and preschools.
e) Emphasis on the importance of inculcating healthy lifestyles from young: Emphasis will be placed on parents and educators recognising that preventing excessive weight gain should begin from young and measures in schools and pre-schools should aim to make healthy eating and regular physical activity a way of life.
f) Involvement of healthcare professionals: Healthcare professionals play an important role in supporting the national strategy through the provision of proper weight management measures in clinics and hospitals.
Public Education to communicate new BMI cut-offs

13. To communicate the new BMI cut-offs to the healthcare professionals, a seminar on “Obesity Management – Implications of Asian BMI Cut-Off Points” will be organised on 19 March for healthcare professionals. The seminar, organised by the Health Promotion Board aims to update them on the new BMI cut-offs, risks for co-morbidity diseases, and provide overviews of obesity management, medical and surgical treatment for obesity.

14. In addition to the year-long activities promoting a healthy lifestyle that HPB organises, HPB will also be organising a series of fun, engaging and interactive activities for the family, to communicate the importance of healthy living, incorporating the importance of knowing one’s BMI and attaining and maintaining a healthy BMI. Highlights of these activities are attached at Annex 2.

15. HPB has also worked jointly with Caltex and NTUC to place BMI machines at selected 6 Caltex petrol stations and 10 NTUC Fairprice supermarkets around the island, from 16-31 March 2005, for the public to conveniently check their BMI free of charge. More details are attached at Annex 2.

16. Public education materials on the new BMI cut-offs have also been produced and will be distributed at polyclinics, hospitals and GP clinics. The public can also obtain information about the new BMI and calculate their BMI on the HPB website at http://www.hpb.gov.sg/

BMI Singapore Context Annex 2

HIGHLIGHTS OF ACTIVITIES TO PROMOTE A HEALTHY LIFESTYLE AND BMI

Healthy Lifestyle Promotion Programmes Held in conjunction with Community Development Councils (CDC)

HPB works closely with North West and Central Singapore CDCs to promote healthy living among their brisk walkers. They include members of all ages who participate in regular walks led by lay leaders. Monthly health talks with a host of interactive activities are organised to raise awareness of healthy lifestyle and impart knowledge and skills on Healthy Lifestyle practices. BMI checks are also conducted to increase the awareness of the importance of healthy weight (BMI).

Two programmes to promote healthy living will be launched with South West CDC and Central Singapore CDC in April and June 2005 respectively.

"Towards Healthy Family Meals" - An initiative to promote healthy cooking and eating in collaboration with culinary professionals and Peoples' Association

Homemakers, especially those who cook for the family, can be great influencers in determining the family’s diet. “Towards Healthy Family Meals” is a new initiative which aims to encourage family to eat healthy.

Four weekly sessions will be offered jointly with the People’s Association, from April – September 2005 in 5 selected Community Centres/Clubs (Sembawang, Ulu Pandan, Chong Pang, Nee Soon Central, Ace the Place @ Admiralty). This interesting programme will equip participants with knowledge and skills on how to buy, prepare and cook healthily. It includes a nutrition talk, practical cooking sessions and a supermarket tour. Participants will also be given a small budget to shop for ingredients and whip up a healthy family meal to “test” their nutritional knowledge and showcase their creativity.

In addition, 2 programmes, "Healthy Cooking with Kitchen Diva Mdm Asmah Laili" will be organised at 8 Community Clubs and "Secrets to Staying Trim" weight management seminars will be organised at 5 Community Clubs. Both programmes include nutrition talks delivered by a nutritionist and BMI checks.

Exercise at the Park ( 3 Apr 05) East Coast Park
A half-day event “Exercise at the Park” will be organised at East Coast Park on 3 April 2005. Organised jointly by HPB, MUIS, Yayasan Mendaki, Berita Harian/Berita Minggu and MERAK (a network of women's committees in mosques), the event is specially organised for the Malay community to incorporate regular physical activity in their daily lives. Highlights of the event include fitness assessments, mass workout, sports stations, family games/competitions, mammography, complimentary BMI checks and dental screenings.

“Heart Health Exhibition”
HPB’s healthy lifestyle exhibition centre will be organising a 3-month long Heart Health Exhibition with the theme “Your Heart.Your Life” from April. This special exhibition aims to educate Singaporeans on the importance of good heart health through innovative exhibits and computer games, forums and workshops. A prelude to the exhibition is a 2-day launch event on 8 & 9 April which will be packed with workshops, contests, health quizzes, celebrity performances and game booths.

Free BMI checks for public at selected Caltex Petrol Stations and NTUC Fairprice Supermarkets
Machines measuring BMI will be available at 6 selected Caltex petrol stations (Caltex Ang Mo Kio 3, Bukit Batok, Dunearn, East Coast, Holland & Tampines) and 10 NTUC Fairprice Supermarkets (Jurong Point, Clementi, Bukit Merah, Tiong Bahru Plaza, Thomson Plaza, Ang Mo Kio, Junction 8, Toa Payoh, Bedok and Marine Parade). BMI measurements at these machines are available free of charge to the public.

BMI Singapore Context Annex 1

TERMS OF REFERENCE AND MEMBERS OF THE TASKFORCE FOR OBESITY PREVENTION AND CONTROL

Terms of Reference

• To assess the problem of obesity in Singapore;
• To study the factors contributing to obesity;
• To review and evaluate current strategies for obesity prevention and control;
• To formulate strategies for obesity prevention and control.

Members of the Taskforce

• Dr Lam Sian Lian (Chairperson) Chief Executive Officer Health Promotion Board
• Mr Chan Mun Wei - Deputy Director (Sports and Youth) Ministry of Community Development, Youth & Sports
• A/P Cheong Pak Yean - President College of Family Physicians Singapore
• Dr Chiew King Tiong Paul - PPA(G)Assistant Director (Veterinary Public Health Laboratory) Agri-Food & Veterinary Authority
• Dr Raymond Chua - Assistant Director (Clinical Audit) Ministry of Health
• Ms Genevieve Chye - Head (Humanities & Aesthetics Branch) Ministry of Education
• Dr Jeffrey Cutter - Deputy Director (Communicable Diseases) Ministry of Health
• Dr Leonard Koh - Senior Consultant (Department of Endocrinology)Singapore General Hospital
• Dr Lee Ee Lian - Consultant (Department of Behavioural Medicine)Singapore General Hospital
• A/P Loke Kah Yin - Senior Consultant (Paediatric Medical Services) The Children Medical Institute, National University Hospital
• Mdm Ng Mie Ling - Director (Strategic Planning)Ministry of National Development
• Mr Gilbert Tan Chye Hee - Assistant Director (Recreation Management Branch) National Parks Board
• Ms Gladys Wong - President Singapore Nutrition and Dietetics Association
• BG (Dr) Wong Yue Sie - Chief of Medical Corps Singapore Armed Forces
• Dr Rose Vaithinathan - Director (School Health Services) Health Promotion Board
• Dr Theresa Yoong - Director (Adult Health Promotion) Health Promotion Board

Co-opted into the Taskforce:

• Ms Amy ChuaDirector (Media Content) Media Development Authority
• Dr Tey Beng Hea - Senior Consultant (General Medicine) Alexandra Hospital

Secretariat

• Dr Mabel YapDirector - (Research and Information Management) Health Promotion Board
• Dr Hong Ching Ye - Acting Head (Special Projects) Health Promotion Board
• Mr Leonard Yeo - Health Promotion Executive (Special Projects) Health Promotion Board

About Energy Systems 4

Fat Metabolism
So to recap, the oxidative system can produce ATP through either fat (fatty acids) or carbohydrate (glucose). The key difference is that complete combustion of a fatty acid molecule produces significantly more acetyl coenzyme A and hydrogen (and hence ATP) compared to a glucose molecule. However, because fatty acids consist of more carbon atoms than glucose, they require more oxygen for their oxidation.

So if your body is to use fat for fuel it must have sufficient oxygen supply to meet the demands of exercise. If exercise is intense and the cardiovascular system is unable to supply cells with oxygen quickly enough, carbohydrate must be used to produce ATP. This typically happens during weight training where short intense bursts of power is used. Put another way, if you run out of carbohydrate stores (as in long duration events), exercise intensity must reduce as the body switches to fat (a slow slow energy source) as its primary source of fuel.

Protein Metabolism
Protein is thought to make only a small contribution (usually no more 5%) to energy production and is often overlooked. However, amino acids, the building blocks of protein, can be either converted into glucose or into other intermediates used by the Krebs cycle such as Acetyl CoA.

The oxidative system as a whole is used primarily during rest and low-intensity exercise. At the start of exercise it takes about 90 seconds for the oxidative system to produce its maximal power output and training can help to make this transition earlier.

Beyond this point the Krebs cycle supplies the majority of energy requirements but slow glycolysis still makes a significant contribution. Slow glycolysis is an important metabolic pathway during events lasting several hours or more.

Energy Systems & Training
Each of the three energy systems can generate power to different capacities and varies within individuals. The literature suggest that the ATP-PCR system can generate energy at a rate of roughly 36 kcal per minute. Glycolysis can generate energy only half as quickly at about 16 kcal per minute. The oxidative system has the lowest rate of power output at about 10 kcal per minute.

The capacity to generate power in each the three energy systems can vary with training and the physical condition of the individual. The ATP-PCr and glycolytic pathways may change by only 10-20% with training. The oxidative system seems to be far more trainable although genetics play a limiting role here too. VO2max, or aerobic power can be increased by as much as 50% but this is usually observed in untrained, sedentary individuals.

Energy Systems Used in Sports
The three energy systems do not work independently of one another. From very short, very intense exercise, to very light, prolonged activity, all three energy systems make a contribution however, one or two will usually predominate.
Two factors of any activity carried out affect energy systems more than any other variable – they are the intensity and duration of exercise. Here is a list of sports and approximately how each of the energy systems contributes to meet the physical demands:



Suggested resources for further reading:
1) Essentials of Strength Training and Conditioning: 2nd Edition. (2000) Baechle TR and Earle RW. Champaign, IL: Human Kinetics
2) Essentials of Exercise Physiology: 2nd Edition (2000) McArdle WD, Katch FI and Katch VL. Philadelphia, PA: Lippincott Williams & Wilkins
3) Physiological models to understand exercise fatigue and the adaptations that predict or enhance athletic performance. Noakes TD. Scandinavian Journal of Medicine and Science in Sports. Issue 10 (2000), pages 123-145
4) Physiology of Sport and Exercise: 3rd Edition. (2005) Wilmore JH and Costill DL. Champaign, IL: Human Kinetics

About Energy Systems 3

(3) The Oxidative System

The oxidative system consists of four processes to produce ATP:

• Slow glycolysis (aerobic glycolysis ending in pyruvate)
• Krebs cycle (citric acid cycle or tricarboxylic acid cycle)
• Electron transport chain
• Beta oxidation

(3.1) Slow glycolysis is almost the same series of reactions as fast glycolysis that metabolise glucose to form two ATPs. The difference, however, is that the end product pyruvic acid is further converted into a compound called acetyl coenzyme A (Acetyl CoA) rather than lactic acid Following glycolysis, further ATP can be produced by funnelling acetyl coenzyme A through the Krebs Cycle.

(3.2) The Krebs cycle is a complex series of chemical reactions that continues the oxidization of glucose that was started during glycolysis. Acetyl CoA enters the Krebs cycle and is broken down into carbon dioxide and hydrogen allowing two more ATPs to be formed. However, the hydrogen produced in the Krebs cycle plus the hydrogen produced during glycolysis, left unchecked would lower the pH in the cells (too acidic). Before this happens, hydrogen combines with two enzymes called NAD and FAD and is transported to the Electron Transport Chain.

(3.3) Electron Transport Chain Hydrogen is carried to the electron transport chain by another series of chemical reactions, and here it combines with oxygen to form water thus preventing acidification. This chain, which requires the presence of oxygen, also results in 34 ATPs being formed.

(3.4) Beta Oxidation Unlike glycolysis, the Krebs cycle and electron transport chain can metabolise fat as well as carbohydrate to produce ATP. Lipolysis is the term used to describe the breakdown of fat (triglycerides) into the more basic units of glycerol and free fatty acids.

Before these free fatty acids can enter the Krebs cycle they must undergo a process of beta oxidation - a series of reactions to further reduce free fatty acids to Acetyl CoA and hydrogen. Acetyl CoA can now enter the Krebs cycle and from this point on, fat metabolism follows the same path as carbohydrate metabolism.

About Energy System 2

The Three Energy Systems
There are three separate energy systems through which ATP can be produced. These systems do not run independently of each other, rather they all act at the same time to greater or lesser extent depending on the factors at work.

(1) The ATP-PCr System

The ATP-PCr is a very fast acting energy system and unfortunately also lasts a very short time. PCr is broken down releasing a phosphate and energy, which is then used to rebuild ATP through a process called phosphorylation. The enzyme that controls the break down of PCr is called creatine kinase.

The ATP-PCr energy system can operate in the presence or absence of oxygen but because it doesn’t rely on the presence of oxygen it said to be largely anaerobic.

During the first 5 seconds of exercise regardless of intensity, the ATP-PCr is relied on almost exclusively. ATP concentrations last only a few seconds with PCr buffering the drop in ATP for another 5-8 seconds or so. Combined, the ATP-PCr system can sustain all-out exercise for 3-15 seconds and it is during this time that the potential rate for power output is at its greatest.

If activity continues beyond this immediate period, the body must rely on the next energy system to produce ATP, the Glycolytic System:

(2) The Glycolytic System

Glycolysis means the breakdown (lysis) of glucose and consists of a series of enzymatic reactions. Carbohydrates supply the body with glucose, which can be stored as glycogen in the muscles or liver for later use.

The end product of glycolysis is pyruvic acid. Pyruvic acid can then be either funnelled through a process called the Krebs cycle (named after Hans Adolf Krebs, winner of the 1953 Nobel Prize in Medicine) or converted into lactic acid. This process occurs regardless whether oxygen is present.

If the end product of glycolysis is pyruvic acid, the process is called slow glycolysis.

If the end product is lactic acid, the process is called fast glycolysis.

As the name suggests the fast glycolitic system can produce energy at a greater rate than slow glycolysis. However, because the end product of fast glycolysis is lactic acid, it can quickly accumulate and lead to muscle fatigue.

The contribution of the fast glycolytic system decreases rapidly after the initial 10 seconds of exercise. This also coincides with a drop in maximal power output as the immediately available ATP-PCr system begins to run out. By about 30 seconds of sustained activity the majority of energy comes from slow glycolysis.

At 45 seconds of sustained activity there is a second decline in power output (the first decline being after about 10 seconds). Activity beyond this point corresponds with a growing reliance on the next energy system, The Oxidative System, perhaps the most complex of the 3 systems.

About Energy Systems 1

ATP - the primary energy source

The ATP molecule consists of adenosine and three (tri) phosphate groups. Energy is released when ATP releases a phosphate to become adenosine diphosphate (ADP). This energy lasts for a very short time only, 5s.
To replenish the limited stores of ATP, a biochemical process called phosphorylation adds a phosphate group back to ADP to create ATP. If this occurs in the presence of oxygen it is labelled aerobic metabolism. If it occurs without oxygen it is labelled anaerobic metabolism (2).

Energy Substrates
Several energy sources, also known as substrates, are available to regenerate ATP. One of these substrates is called phosphoCreatine (PCr).

PhosphoCreatine (PCr) : is readily available in the muscle cells and rapidly regenerates ATP. However there is only about 100g of ATP and about 120g of PCr stored in the body, mostly within the muscles.

Fat : Fat is stored predominantly as adipose tissue throughout the body and is a vast energy reservoir. Fat is not quickly accessible for cellular metabolism because it must first be biochemically converted from its complex form, triglyceride, to the simpler components of glycerol and free fatty acids. So although fat acts as a vast stockpile of fuel, its energy release is too slow for very intense activity.

Carbohydrate : Unlike fat, carbohydrate is not stored in peripheral deposits throughout the body. At rest, carbohydrate is taken up by the muscles and liver and converted into glycogen, as blood glycogen and muscle glycogen. Glycogen can be used to form ATP and in the liver it can be converted into glucose and transported to the muscles via the blood. A heavy training session can deplete carbohydrate stores in the muscles and liver, as can a restriction in dietary intake. Carbohydrate can release energy much more quickly than fat.

Protein : Protein is used as a source of energy, particularly during prolonged activity, however it must first be broken down into amino acids and then converted into glucose. Similar to fat, protein cannot supply energy at the same rate as carbohydrate. The rate at which energy is released from the substrates is determined by a number of factors, including the diet, the physical and physiological condition of the individual.

Glucogenesis is the process of synthesizing glycogen from glucose. When the body chooses to store ingested carbohydrates in the muscles or liver, it must first be converted to glycogen.

Glycogenelysis is the process of glucose formation from glycogen. Before stored glycogen can be used as an energy substrate, it must first be converted to glucose.

Gluconeogenesis is the process of converting a non-carbohydrate substrate such as protein or fat into glucose.

Next : The 3 Energy Systems

About Personal Trainers

A Personal Trainer (PT) is a person who you engage to advise and coach you in your training programs. Simple.

Your training program may be in track and field, or in resistance training, or swimming or .... there is a personal trainer for most physical activities including porno videos.

You can go through the physical activity yourself without a PT. If you're knowledgeable enough then you can guide yourself and likely achieve results. If you're clueless then you may spin for years going nowhere.

What to expect from a PT

The most important requirements of a PT are

1. to be able to ensure his client learns what he is teaching
   
2. to be able to ensure the safety of his client
3. to be able to motivate his client
4. to be able to follow through with his client

Academic or paper credentials are good to the extent of being knowledgeable in the field. But this does not necessarily make him a good PT. A PT's physical looks does not have to match the sport he is teaching, for example a gym PT does not have to be more muscular than his client; nor a football PT have to score more goals than his client. It helps the image, but it is not that important.

PTs have to earn a living too. They would rather get paid for their services than give their services for free. The going rate is S$30/hr for new PTs to S$80/hr for experienced PTs to S$200/hr for specialist PTs. PTs may be regular employees of a gym, or they can be freelance too.

Engaging a PT

How do you engage a PT without knowing the quality of the PT ? You'll be spending lots of money based on sales pitch and faith. Here's what you can do:

• Ask the PT to describe what he will do for you
• Ask the PT for 1 trial session, pay for it
• Tell the PT you are guaging the quality of his teaching
• Tell the PT you will not sign on if you are not satisfied , don't be shy

It is perfectly acceptable to pick and choose a PT. Just as when you are shopping for a massage chair, you would go to the various dealers and ask to try it. You are under no obligation to buy. When it comes to choosing a PT, ask the gym staff to introduce you to a PT, making clear that you are checking on the quality of the PT and under no obligation to engage him. If you're not satisfied, just go to the next gym branch and do it again.

Minimum standards for a PT

A PT who doesn't go through a PAR-Q session with his would-be client is not a PT you should engage.

• P - Physical
• A - Aptitude
• R - Readiness
• Q - Questionaire

The PAR-Q is designed to ascertain whether a person's physical condition allows him to engage in certain physical activities. The range of activities available depends on the answers to the question, such as a woman in her 2nd trimester of pregnancy, or an elderly person or a person with diabetes would all have their range of activities they can safely engage in.

In a gym setting, the credible PT will begin by inviting would be clients to talk to him about their training aspirations. The PT would then describe the advantages of engaging his services. If the client is agreeable, the PT would administer the PAR-Q test and the following:

1. measure height, weight, body fat, blood pressure, circumference
2. (sub)-maximal aerobic capacity on stationary cycle
3. flexibility, for example using the stretch and reach test
4. 1RM strength test

Based on the assessment above, the PT would then:

• prescribe a progressive exercise program tailored for this client
• demonstrate the exercises, including safety measures
• monitor the client through the exercises and correct
• evaluate the clients progress over time and re-assess
• follow through with the client outside PT hours

The value of a personalized exercise program, if properly done, cannot be overstated. This is 1 key tool towards achieving the body you want. It may not work for other people, because it was not specially tailored to their physical condition.

The last point - follow through with the client outside PT hours is particularly important. Most PTs responsibility ends at the 1 hour PT session, but an outstanding PT will follow through with his client outside the 1 hour, for example with regards to the client's continue physical activities, dietary habits, etc.

I am reminded of the acronymn EMPAS when demonstrating an exercise station to a client. The credible PT should:

• E - exercise. Describe the exercise
• M - muscle. Describe the muscles involved
• P - posture. Describe the correct posture
  
• A - action. Describe the action and proper form
• S - safety. Never forget the safety aspects.

The PT should give all his 1 hour to his client. The PT should not engage in his own training nor chatting with his friends or into his hp during that 1 hour. After all, you're paying him for his 1 hour. The PT should be monitoring you and correcting you as you go along.

After a suitable period, perhaps 8-10 weeks, the PT should evaluate your progress, reassess your physical condition and prescribe another training program.

About Risk Factors

Heart Disease is one of the leading causes of death in many countries, including Singapore. An understanding of the risk factors contributing to heart disease is important to secure one's quality of life, for a lifetime.

The National Institutes of Health(NIH), USA , the Center for Disease Control (CDC), USA and many other respected medical institutes have adopted an 8 factors classification, collectively known as Risk Factors for Cardiovascular Disease. These are:

1. Family History - Myocardial infarction, coronary revascularization or sudden death before age 55 in male descent, or before age 65 in female descent.

2. Age - current age of more than 55 for males and 65 for females.

3. Smoking - Current smoker or those who quit within the last 6 months.

4. Hypertension - Systolic blood pressure of more than 140 mmHG or diastolic of more than 90 mmHG; confirmed by at least 2 separate occasions 7 days apart

5. Hypercholesterolemia - Total serum cholesterol of more than 200 mg/dL or HDL less than 35 mg/dL. If LDL is available, then use more than 130 mg/dL rather than total cholesterol. A high HDL is considered a bonus which can be used to offset another negative risk factor.

6. Diabetes Mellitus - Fasting blood glucose of more than 110 mg/dL at 2 separate occasions.

7. Obesity - BMI of more than 30 or Waist circumference of more than 100cm.

8. Sedentary Lifestyle - Persons not participating in a regular exercise program or meeting the minimal physical activity recommendations from the US Surgeon General's report (of 3x/week lasting 20min-30min each time).

Unalterable factors are : Age (we all grow old) and Family History (we're born into the family, we didn't choose it) and Diabetes (Type 1 diabetes starts from birth, Type 2 is developed and possibly alterable).

The other risk factors are alterable. For example: quit smoking , switch from a sedentary lifestyle to an active lifestyle, reduce the BMI etc.

Blood Cholesterol Levels - Cholesterol is a waxy substance produced by the liver or consumed in certain foods. It is needed by the body, and the liver makes enough for the body's needs. When there is too much cholesterol in the body—because of diet and the rate at which the cholesterol is processed—it is deposited in arteries, including those of the heart. This can lead to narrowing of the arteries, heart disease, and other complications.

Some cholesterol is often termed "good," and some often termed "bad." A higher level of high–density lipoprotein cholesterol, or HDL, is considered "good," and gives some protection against heart disease. Higher levels of low–density lipoprotein, or LDL, are considered "bad" and can lead to heart disease. A lipoprotein profile can be done to measure several different forms of cholesterol, as well as triglycerides (another kind of fat) in the blood.

High Blood Pressure - High blood pressure is another major risk factor for heart disease. It is a condition where the pressure of the blood in the arteries is too high. There are often no symptoms to signal high blood pressure. Lowering blood pressure by changes in lifestyle or by medication can lower the risk of heart disease and heart attack.

Diabetes Mellitus- Diabetes also increases a person's risk for heart disease. With diabetes, the body either doesn't make enough insulin, can't use its own insulin as well as it should, or both. This causes sugars to build up in the blood. About three–quarters of people with diabetes die of some form of heart or blood vessel disease. For people with diabetes, it is important to work with a healthcare provider to help in managing it and controlling other risk factors.

Smoking - Tobacco use increases the risk of heart disease and heart attack. Cigarette smoking promotes atherosclerosis and increases the levels of blood clotting factors, such as fibrinogen. Also, nicotine raises blood pressure, and carbon monoxide reduces the amount of oxygen that blood can carry. Exposure to other people's smoke can increase the risk of heart disease even for nonsmokers. Smoking is an addiction, pure and simple. Smokers often refuse to acknowledge this fact, for them it's preferable to smoke and die than to quit and live.

Smoking is the single most avoidable cause of death. On a global scale, the World Health Organisation (WHO) estimates that tobacco kills one person every 10 seconds. Smoking causes cancer and is a major risk factor for coronary heart disease, stroke and chronic obstructive lung disease. Together, they account for close to two-thirds of all deaths in Singapore in the year 2000. (Health Promotion Board, Singapore). Despite this, the Singapore Government does not ban the import/sale of cigarettes while it has banned the import/sale of sex magazines. Amazing Singapore !

Cholesterol - Several aspects of peoples' dietary patterns have been linked to heart disease and related conditions. These include diets high in saturated fats and cholesterol, which raise blood cholesterol levels and promote atherosclerosis. High salt or sodium in the diet causes raised blood pressure levels.

Sedentary Lifestyle - Physical inactivity is related to the development of heart disease. It also can impact other risk factors, including obesity, high blood pressure, high triglycerides, a low level of HDL (good) cholesterol, and diabetes. Regular physical activity can improve risk factor levels.

Obesity - Obesity is excess body fat. It is linked to higher LDL (bad) cholesterol and triglyceride levels and to lower HDL (good) cholesterol, high blood pressure, and diabetes.

Heredity - Heart disease can run in the family. Genetic factors likely play some role in high blood pressure, heart disease, and other vascular conditions. However, it is also likely that people with a family history of heart disease share common environments and risk factors that increase their risk; for example traditional dietary habits of the family.

Monkey See Monkey Do

There are gymmers who know what they are doing, they monitor their progress and make adjustments to get to where they are going.

There are gymmers who are totally clueless. One wonders why they've stuck to the gym wagon all this time.

Then there are gymmers who watch what you do, then copy what you do.

It is this 3rd group of gymmers which I'm writing about today because of 2 incidents which happened to me recently.

I came up with a series of isolation exercises targetting my teres muscles and separately, my medial and posterior deltoids. When I do this series, I focus and I concentrate the flexion where I want it.

Lo and Behold ... some gymmers started copying what I did. .They're regulars and I've never seen them do this before, they couldn't have because I only just designed it for myself out of thin air. Looking at them, they are clueless what muscles are being targeted doing these series of exercises. They have no focus, they just go through the motions. They don't even have the necessary development in the muscles to effectively do this series.

The successful gymmer is the knowledgeable one, someone who feels his body and listens to his body. He designs his own progressive exercises to suit his muscular development at that point in time. Before too long, he sees significant improvements to his muscles and he adapts his routine to take this into account. This is the gymmer who makes the most progress in the gym.

Monkey See Monkey Do will get you nowhere. The exercises the knowledgeable gymmer does is tailored specifically for his body and his level of development. That's just the visible aspect of it. You don't know his targetting imagery, his focus and his concentration just by looking at him. Try copying his movements and you will find either you can't do it or you can't feel the effects of it. Simply because he designed the exercise for himself, not for you.

So what's the novice (including those of many years) gymmer to do ? Simple, ask the gym trainer to show him the right way to workout. SSC ClubFit and Safra EnergyOne trainers are obliged to do this for free; it's their job. Or if the particular gym does not give free handouts, then pay a personal trainer to help you.

About Slimming Gadgets

Fake Fake Fake

You can fool some people all the time and all of the people some of the time. But you can't fool all of the people all the time.

Singapore and apparently the rest of the affluent 1st world countries is caught in the mire of quick fixes. Have Money - Can Fix. Many people still cannot accept that money doesn't buy everything. One of these things money can't buy is a miracle to lose fat.

Legislation in Singapore is woefully inadequate to protect the unwary consumer from claims of painless, effortless, fashionable weight (fat) loss. The law protects free enterprise as long as no medical claims are made, the law does not protect the stupid consumer. Caveat Emptor - let the buyer beware.

Gadgets do not correct the underlying problem; which is a lifetime of horrible dietary habits and sedentary lifestyle. Nature always take the path of least resistance (electric current comes to mind, river water comes to mind). In this case, the path of least effort is Eat More, Vegetate in Front of the TV, Pop a few Pills, Wear a Vibrating Belt. Is it any wonder then that these people still remain fat ?

Compare these overweight couch potatoes to the guy running in the park and working up a good sweat. Is it apparent now which lifestyle gives a slimmer you ? Ever see a fat athlete ? Well, let's not include Sumo Wrestlers or Tire Flipping Hulk Hogans.

Vibrating Belts do not work (actually if I ever figure out how to wrap the vibrating belt around my cock, I might just go out and get one !). There is no medical basis for claiming it melts off fat and gives a trimmer tummy.

Herbal Wraps do not work. Most of the weight loss in body wraps comes from sweat. The weight comes back on when you drink water. Might as well just sit in a sauna and sweat it out.

Pill Popping works for a while.

• In some pills (example Hydroxycut) the body quickly adapts to the stimulants and the thermogenic/metabolic effect wears off. Feedback from friends indicate this is about 2-3 weeks.
• In other pills (Xenical) which prevents your intestines from absorbing the oil you ingest (you pass oily shit or leak oil from your anus), the effect lasts only as long as you take it.
• Medications to manipulate your hormones, example T3 which is secreted by the thyroid gland is one of the most powerful metabolic agents in the body. Inexpert supplementation with T3 and you end up with thyroid atrophy (malfunction) and you'll have to depend on medication for the rest of your life.
• Bottom line: do you want to pop pills for the rest of your life ?

Beware the marketing hype. Often, these are based on limited laboratory trials (example, using rats) and fantastically extrapolating to the obese human being.