Health tip of the month

Dr. Maninder Ahuja

Faridabad
E-mail : ahuja.maninder@gmail.com

Stair climbing in proper way

Where ever we go we find stairs and improper stair climbing damages our knees but done in the proper way it BECOMES AN EXERCISE.

Most of Indian women have knee  problems and they are basically because of our  habits of squatting  on the floor which damages our knees,but proper squatting and proper stair climbing can be rather protective for our knees.

So here we would tell you advantages and techniques of proper stair climbing.

Proper stair climbing is best way of integrating exercise into your daily life routine as most of us are doing it or can do it daily. So learn to strengthen your leg muscles by proper stair climbing.

Stairmaster machines are among the most popular pieces of exercise equipment in gyms all over the world but these machines can be substituted by stair climbing in a proper way in our own homes or where ever we find them and some of the reasons are:

• It is totally free and all of us can get access to stairs.
• It is against gravity and the heavier we are, the harder we're forced to work and the more calories we burn.
• It is a relatively intense exercise that quickly increases our heart rate and in doing so can greatly improve our cardiovascular fitness.
• It helps strengthen and shape our most common problem areas like calves, thighs, buttocks and tummy. .
• Climbing stairs for weight loss and fitness is an excellent exercise.
• It is a very efficient way of burning maximum calories and is good for those of us with limited time to exercise.
• It can easily be mixed with other exercises, like walking, skipping and weight training, to maximize results and stair climbing workouts are easy to progressively increase.
• It can be done by almost anyone, regardless of fitness level.
• Because it is weight bearing, it helps build bone strength.
• It is low impact and safe for the knees (provided correct technique is used and a preexisting condition doesn't exist).

Getting started climbing stairs

We come across stairs at many places. So use stairs instead of using escalators or lifts.

Getting the most out of stair climbing

• With any form of exercise it is important to start off slowly and then increase our workouts, and stair climbing is in the same way.
• To help our body acclimatize to this form of exercise, we should start by limiting ourselves to walking up two flights of stairs followed by five minutes of walking on the spot. At the end of the 5 minute walk on the spot, when our heart rate has come down a bit, we can try walking up another two flights followed by another five minute walk on the spot. This may be enough of a workout for us in the first week or two.
• When we start to get even fitter and stronger, then we can go further by :
• Lengthening the time of our workouts (doing more sets).
• Climbing two steps at a time instead of one.
• Adding to our body weight with a weighted belt, weighted vest or carrying dumbbells.
• Reduce our rest intervals.

Aerobic versus anaerobic stair climbing workouts
Depending upon how we use them, stairs can predominantly improve our aerobic fitness or our muscle strength, it is better to keep breathing properly and not to go beyond your aerobic stamina

For strength improvement it is best to walk up two steps at a time and limit the number of sets of stair climbs we do per workout to between 1 and 5 sets. And instead of running up 20 flights of stairs, it may only be necessary to walk up a total of 15 to 30 steps per leg.
We can change styles for our various thigh muscles.

Most important thing to learn is that when we put on foot forward we should lift the back foot and we should not bend our knees so that our knees don't go beyond our toes. This way we don't transfer our body weight to our knees and we don't damage our knees. (fig -1 to fig-4).

FIG -1 Wrong step as knee is going beyond toes (WHITE ARROW)

FIG-2: First Step	FIG-3: Second Step	FIG-4: Third Step

Here are some tips for working the inner thigh, hips and buttocks using stairs:

• To work the inner thigh: stand sideways at the bottom of the stairs, place your hand on the rail (if available) for balance. Lift your right foot and place it on the first step. Transfer your weight onto your right leg as you lift your left leg and cross it over your right and up to the next step. Continue up the stairs in this fashion until you've reached the desired number of repetitions.
• Wrong! Knee should not go beyond toe To work the buttocks:  start at the bottom of a flight of stairs, step up with your left leg and kick your right leg back (contract your right buttock when you do this), and then repeat with the right leg and left kick. Continue this until you've reached the desired number of reps.
• To work the hip abductor :( the muscle on the outside of your hip that moves your leg out to the side); stand on a stair step sideways with one foot on the step. Without bending the supporting leg, lower the unsupported leg a couple of inches by tilting your pelvis, and bring it back up. Repeat 10 times and switch to the other leg.

To get the most benefit out of any aerobic exercise, we should do it at least 3 times a week, for at least 20 minutes per session, at an intensity that elevates our heart rate to between 60% and 90% of our maximum heart rate .MHR(maximum heart rate is 220 –age in years and for example for fifty years old this 220 -50 = 170 and 60% is 112 and 90% is 153 so our heart rate should be between 112 and 153 depending on whether we are doing moderate or vigorous intensity exercise.

For a combined aerobic and anaerobic workout, alternate five minutes of stair climbing with sets of exercises like push-ups, sit-ups, dumbbell curls and presses.

A combined workout example might include a five minute warm-up, thirty to forty minutes of intervals (consisting of 2-3 minutes of stair climbing followed by 1 minute of muscle toning exercises), a five to ten minutes cool-down and stretches.

To help avoid boredom we can:

• Cross-train using other activities such as bicycle riding, walking, jogging, etc.
• Use music to motivate us - wearing a portable radio, CD player or an iPod allows us to listen to all our favorite songs while climbing.
• Keep an exercise diary and track our progress - nothing motivates like success!

Safety tips for stair climbing

Generally speaking, stair climbing is relatively safe for most of us, but as with anything it is not totally without dangers.

• • Always warm up and stretch before climbing stairs, paying particular attention to the major leg muscles (calves, hamstrings, thighs and buttocks).
  • Start out slow and easy, and don't increase our intensity by more than 10% each week.
  • Be very careful coming down stairs. Don't come down too quickly and NEVER run down stairs, it's far too dangerous for no or little gain.
  • Put our safety first and go at a speed that ensures we don't lose our balance or strain too hard.
  • Wear a heart rate monitor so that we can see how hard our heart is working and to ensure we stay within the desired target heart rate, or according to talk test or Borg's test of self perceived exertion.
  • Take lots of water in-between.
  • Stop if you feel faint, dizzy or in pain.
  • Take sufficient rest breaks during your workouts.
  • Always consult your doctor before beginning any new exercise routine.

• Do not climb stairs if you have orthopedic or medical complications (such as high blood pressure, etc)
• Maintaining the correct posture while climbing stairs is very important to get the most out of our workout and minimize the chance of injury
• Cool-down period that allows our heart rate to gradually return to about 100 beats per minute is important.
• Dress comfortably and suitably. Newer synthetic workout fabrics tend to pull moisture away from the body and help keep us cool and dry.
• Always wear appropriate footwear in the form of comfortable, well-cushioned cross-training athletic shoes.
• Always use stairs that have good light and ventilation.

Conclusion

Climbing stairs is a great way to lose weight, improve our fitness and tone and strengthen our legs, tummy and buttocks.

This article was to explain how such routine activities like climbing stairs, is such an excellent exercise for those of us with weight loss goals, and also to give some very useful tips for you to get started for stair climbing and doing so safely and effectively.

Dr. Maninder Ahuja

 

Leg Exercises For Fitness

Dr. Maninder Ahuja

We have the maximum number of knee replacement surgeries in our country and a large number of men and women are limping, having pain and knee problems after 40 years of age.If we take proper care of strengthening our leg muscles we would be able of avoid a number of knee surgeries.

We need our leg muscles all the times, while   doing our routine chores of life and this can't be done without strong leg muscles .Walking is a good exercise but for walking to be effective we again need strength of our leg muscle.

So here I am giving some of knee strengthening exercises.

Warm up
Before we start any strength building exercise warm up is a must.
Warm up can be stationary or dynamic warm up.
Dynamic warm up is by tread mill or cycling or even walking.(fig 1- 3)
If you are doing with tread mill see to it that the surface is not inclined. Warm up  by simple walking can be from 10 -20 minutes depending on how many calories you want to burn or by stationary cycling for 5- 10min.
If you have to lose weight then these exercises can be for longer period like 15-20 min but for toning up and strength building warm up 5-10 min. is ok.
Stretching the muscles you are going to exercise is also very important so that you don't damage your muscles while doing strength building.

Walking as an exercise

• Walking to be effective has to be at a brisk pace.
• Slow walking does not give any benefits of weight losing or even for cardioprotection.you should do at a pace that you are barely able to talk.
• Foot wear should be proper and ideally it should not be on hard surface

Leg exercises

Leg exercises should be done to strengthen your all leg muscles and give them full range of motion and some of these exercises are following which can be done at home.

Stretching is a vital component of any exercise program. A brief stretch after any workout is a nice way to relax-and it helps prevent injury and maintain flexibility..

HAMSTRING STRETCH

Sitting on the ground, with one leg straight and the other one comfortably bent in front of your body, bend at the waist and lean forward, keeping your back as straight as possible and don't arch it.  Reach with your arms towards the foot until a stretch is felt under your thigh.  Hold each stretch for a minimum of 30 seconds, any less than 15 seconds and the muscle will not conform to the new increase in length.  Do 3 reps, 3-6 times a day.  Any pain you feel with this exercise should only be a local stretching sensation to the back of your thigh area, without aggravating your condition.

Gluteus Stretch

Lying down on your back, bend your right knee, and place your left leg over the right leg, resting the outside of the left ankle slightly above the right knee.  Place your right hand around the outside of your right thigh and place the left hand around the inside of your right thigh.  Lock the two hands together.  Now pull forward towards your chest to achieve a stretch in the left gluteus portion of your buttocks.  Do the exact opposite to achieve a stretch of the right gluteus portion of the buttocks.  Hold each stretch for a minimum of 30 seconds, any less than 15 seconds and the muscle will not conform to the new increase in length.  Do 3 reps, 3-6 times a day.  Any pain you feel with this exercise should only be a local stretching sensation to the back of your thigh and buttocks area, without aggravating your condition.

Calf Stretch

Start with stretching the right Gastrocnemius portion of the right calf area. While standing, place your right leg in front of you and your left foot directly behind you.  Place the toes of your right forefoot up against a door or other flat wall surface, keeping your heel down to the floor. Lean against a wall or other stationary object, both palms against the object. The leg you want to stretch is back, several feet from the wall, your heel firmly positioned on the floor. Your other leg is flexed about halfway between your back leg and the wall. Start with your back straight and gradually lunge forward until you feel the stretch in your calf. "It is important to keep your back foot straight and angled 90 degrees from the wall,".  Hold each stretch for a minimum of 30 seconds.  Any less than 15 seconds and the muscle will not conform to the new increase in length.  Do 3 reps, 3-6 times a day.  Any pain you feel with this exercise should only be a local stretching sensation to the calf area of the leg, without aggravating your condition.

Quadriceps Stretch

Start with stretching the left Quadriceps muscle.  While standing hold a solid surface for support and bend back your left leg.  Grab your left ankle and pull that foot to your left buttocks while simultaneously pulling your left thigh backwards while keeping your back straight.  Pulling your thigh backwards is a very important part of this stretch, as it will place the stretch in the mid-thigh instead of overloading the pressure on the knee.  Do the exact opposite to achieve a stretch of the right Psoas portion of your front upper thigh area.  Hold each stretch for a minimum of 30 seconds.  Any less than 15 seconds and the muscle will not conform to the new increase in length.  Do 3 reps, 3-6 times a day.  Any pain you feel with this exercise should only be a local stretching sensation to the Quadriceps muscle area of the upper thigh, without aggravating your condition.

Inner side of thigh muscles stretch or adductor stretch

Our muscles do not work alone when we perform certain exercises. Our adductor muscles are working simultaneously with others while doing squats, leg presses, or lunges. Make sure that your adductor muscles are in their good condition every time you perform stretching activities.
To stretch the groin simply place the feet together pull in toward yourself grab onto your ankles and apply force with your elbows down on your legs. If you're doing this stretch correctly you'll feel a pulling on your upper inner thigh.

Front Lunge

The lunge is a dynamic exercise that targets the muscles of the thighs, back, and buttocks, Strengthening the bones in the hip and spine. The wide leg squat addresses the same muscles, But the lunge includes balance and coordination as well.

Starting position: Stand next to table or counter with your feet hip-width apart, knees Slightly bent. Lightly hold on to the counter with one hand.
1-2-3-Forward: Take a large step forward with your right leg. Land on the heel of your right foot, and then roll your foot forward until it is flat on the floor. Keeping your body erect, bent both knees so that your hips drop straight down. Your front thigh should be almost parallel to the floor, and the knee of your back leg should approach the floor. The knee of your forward leg should be over your ankle, not past your toes. The heel of your back leg will come off the floor. Your weight will be equally distributed between your front foot and the ball of your back Foot.

This exercise can be done with holding free weights in your hands, and as your strength goes on increasing you can increase weights or you can do with weights attached to a barbell and barbell is held at the upper part of your back.

Pause for a Breath

Return: Push back forcefully with the front leg to return to the starting position.
Pause for a breath, and then repeat the move.
Reps and Sets: Alternate legs as you step forward until you have done 8 reps with each leg – this
is 1 set. Rest for a minute or two and do a second set.
This exercise can be done without weights or slowly you can add weights.

Wide Leg Squat

It strengthens the muscles of your front, back, and inner thigh as well as your buttocks and the hip-bones, i.e. hamstrings, quadriceps and gluteus muscles.
Stand about 6 inches in front of the chair with your feet a little wider than shoulder-width apart. Take a deep breath and flex your knees and then aim your buttocks back and slowly lower yourself into the chair. Your knees should remain above your ankles; your knees should never go beyond your toes.
Pause, and slowly stand. Then repeat the move 8–10 times and three sets of same repetitions.

You have to do these exercises after gap of 2-3 days only so that you don't overburden your muscles.

So be cheerful keep smiling and laughing and strengthen your leg muscles so that you  can run around happily and have a quality of life.

Dr. Maninder Ahuja

 

Make your life colorful

When I was invited by Dr.Nozer Sheriar to write on health tips for our FOGSI web site I was in a dilemma. Now why that dilemma was there? I have to write for a professional organization but at the same time I have to sensitize our medical fraternity about various life style modifications, which I tell you are really loathsome, to take up practically.

How we are tackling our patients we tell them "exercise karna" (do some exercise) how many of us go beyond that?

And what about everybody's daily routine life?

We have evolved from an era of physical activity where we did not have any tools except our own hands and feet and as we started progressing, we stopped using them less and less and with so much advanced technology what activity remains is just up to the level of moving our finger tips to various controls and we are just carrying our own body weight!

What patients and all of us want to do is "PILL POPPING" What we are working on talking on is how to cut a patient and how many pills or injections should be taken every day.

Are we not slaves of our own inventions and we are fools thinking we invented them for our own quality of life but we are moving away from that "quality of life ". So much away that coming back won't be possible.

These problems are two folds, science of exercise developed very late. Till 1953 bed rest was panacea for all diseases starting from tuberculosis to heart disease.

So when we started thinking about exercise as a therapy and as a preventive measure?

Till  mid twentieth century role of physical activity and exercise was not well understood in medicine and it was in 1953(Fig-2) that first study was done in drivers and conductors of double Decker buses by Professor Jeremy Morris in London.

Fig - 2

Conductors who ran up and down the stairs of buses had much lower incidence of CHD mortality because of coronary artery disease as compared to drivers who sat at steering wheel whole day, and this highlighted the role of exercise in coronary artery disease. Now that was the beginning of our field of exercise science, systematic work on physical activity and health.

This was the starting point of  journey of physical fitness through exercise. After this there have been a large number of studies to highlight role of exercise and physical fitness throughout life  for prevention of metabolic syndromes and for therapeutic purposed also. There have been more and more e studies from 1980 onwards and in 2005-2006 more than 20,000 articles on physical fitness were published. (Fig-3)

From here starts our sojourn together on telling you about physical fitness exercise and their scientific basis is going to change our "QUALITY AND QUANTITY OF LIFE"

What does exercise mean?

Structured physical activity of exerting your muscles in various ways to keep fit. But how to go about this activity  is not clear not only to medical community but also for general public and whatever  knowledge is there is being utilized to train the athletes and sportspersons and not for general public health. The questions, "How much exercise is enough?" and "What type of exercise is best for developing and maintaining fitness?" are frequently asked.

Thus, the need for guidelines for exercise prescription is apparent. Based on the existing evidence concerning exercise prescription for healthy adults and the need for guidelines, the American College of Sports Medicine (ACSM) and other institutions have made some  recommendations for the quantity and quality of training for developing and maintaining cardio respiratory fitness, body composition, muscular strength and endurance, and flexibility in the healthy adult:

Prescription of exercise

Now exercise/physical activity is for health and fitness in the context of an exercise dose continuum. That is, there is a dose response to exercise by which benefits are derived through varying quantities of physical activity ranging from approximately 700-2000 plus kilocalories of effort per week. Many significant health benefits are achieved by going from a sedentary state to a minimal level of physical activity; programs involving higher intensities and/or greater frequency/durations provide additional benefits .But all the exercises have to be according to needs of the person so that is why we are talking about prescription of exercise.

Prescrtiption of exercise would consist of :

• Type of exercises
• Duration of exercises
• Intensity of exercises
• Change in exercise as fitness is increased

But  I have to tell you something  now, so that you are busy till next update?

Start walking, and at a moderate pace and yoga do just as a stretching exercise.

These are your warm up exercises and keep walking till I talk to you again.

Stop , Stop not till then only 40 -45 min /day if you want to lose weight and for cardio respiratory endurance 30min/day would be ok but at moderate to vigorous intensity.

So in next update prescription of exercise with regards to intensity of exercise.

Dr. Maninder Ahuja

Faridabad
E-mail : ahuja.maninder@gmail.com

Strengthening the Back Muscles

In menopause, weakest part of skeletal system is back bone.
It is important because this is central support system of our body.
If we have weak backbone then who would carry weight of our axial skeletal system?

• So strength of back bone is of utmost importance in our whole life but more so in menopause as our legs and arms are also getting weak because of loss of muscle mass and if we don't have strong central support system consisting of back bone and abdominal muscles, our chances of falling down and sustaining fractures are also increased.
• All of you must have seen most of the middle aged women bent at the back, this is called kyphosis or dowager hump .you would be losing height, and you would be feeling fatigued. If there is loss of more than 1.5 inches then it means you already have had micro fractures of spine.

This hump is because of weak extensor muscles of the back along with very small fractures of the upper back bone which go unnoticed most of the time and are not diagnosed in more than 1/3 rd of cases.This interferes with quality of  life of women.

• Along with quality of life issues is issue of medical problems of chronic back ache, decreased  chest space so respiratory problems , and decreased abdominal space so problems of digestion.

What you have to do for prevention and treatment is back strengthening exercises along with calcium and Vit.D.

When should these exercises be started ?
In early forties or mid forties ?
No !! perhaps earlier if possible but then definitely thirty five years onwards.

Why? Because  this is the age when you start losing your muscle strength and your bone mass.

Till what age you build up your muscle mass and bone mass ? It is about 25 years of age. What happens then, there is almost a plateau till about let us say 35 years of age or so and from that age onwards you lose bone mass and muscle mass at the rate of about 0.5 to 0.75% /year  and this loss increases to about 4-5% per year around the age of menopause

Fig -1 BONE MASS WITH AGE, (max BMD reached till 25 years and then plateau till 35 -40 years and then decrease starts)
So start as early as possible but definitely from just beyond thirty.
You have micro fractures of your spine even while bending to lift up some weights.
Therefore  take  precaution  to prevent these fractures:

• You don't bend yourself at the spine but at the knees when picking up some objects.
• Secondly train your back muscles by doing resistance exercises like seated rows or wide grip pulley press. While doing seated rows don't bent forward at the back,
• You can do back bridges.
• You can do some yoga exercises also like cobra pose or Bhujang asan.
• We should strengthen core muscle together .Core muscles are abdominal and back muscles and as they take the weight of our appendages or limbs, it is very important to strengthen our core muscles.

These exercises  would increase flexibility and can help to stabilize the back.  However, it should be noted that for most of these exercises, you should not feel the stretch in the back itself.  For example, the back of the legs have a group of muscles called the hamstrings.  These muscles originate in the lower pelvis and insert into the leg.  When the hamstrings are tight, the back itself can  be tightened due to the pulling on the pelvis.  Therefore, stretching the

• hamstrings will not only loosen the leg muscles up but they will take the strain off the back.
• As each back condition is different,  always consult your doctor before performing any of these exercises to determine what exercises, if any, are right for your particular condition.  If you have any discomfort after performing any of these exercises, discontinue and immediately and consult a doctor to properly assess your situation.*

Following are some of these exercises  which is a combination of  stretching, with strength building and some yoga asnas.

Back Bridge :

Fig: 1 Back Bridge.
Back bridge:
Lie straight on a mat. Bend your knees and raise your torso in a straight line as shown in figure. Don't arch hold for 10 sec and repeat it again 10 times and 3 sets of these 10 repetitions.

Sit-ups

FIRST STEP

SECOND STEP

Sit-up exercises should be done very precisely to avoid any traction to the spine.  Place your knees up on a chair, with your legs and hips at a 90 degree angle. First breathe out then breath in and pull your abdominal muscles or your belly button towards floor thiswould tighten your internal abdominis muscle, this is your first step.
Support your neck but don't pull on it as you raise your upper chest, no more than 30 degrees.  Look straight up with your eyes to keep from pulling forward on the head.  Do 3 sets of 12 reps, or to your individual tolerance.  It is important to concentrate on feeling the strain in your abdominal muscles and not your neck or back.  Any pain you feel with this exercise should only be a local muscle exercising sensation to the abdominal area, without aggravating your condition.

Hamstring Stretch

Sitting on the ground, with one leg straight and the other one comfortably bent in front of your body, bend at the waist and lean forward, keeping your back as straight as possible.Don't curve your back. Reach with your arms towards the foot until a stretch is felt under your thigh.  Hold each stretch for a minimum of 30 seconds, any less than 15 seconds and the muscle will not conform to the new increase in length.  Do 3 reps, 3-6 times a day.  Any pain you feel with this exercise should only be a local stretching sensation to the back of your thigh area, without aggravating your condition.

Back Flexion Stretch

While lying on your back, pull both knees to your chest while simultaneously flexing your head forward until you reach a comfortable stretch in a balled-up position.  Do 8-12 repetitions this way holding each one for 8-10 seconds at a time.  You should feel no pain with this exercise, as the stretch is designed to relieve tension on the back.

Strength Training Exercises :( Instruction for the patients on steps of exercises) Upper Body

Dumbbell Row

• Place the opposite hand on the bench for support. Place one foot slightly behind hips on the ground with  knee slightly bent; place the other knee on the bench below hips.Back should remain flat and head should stay focused straight ahead.
• Grasp the dumbbell in one hand. Begin the exercise with the weight arm-length away. Slowly pull the weight to the chest while squeezing shoulder blades together.
• Think of the hand as a hook and pull the weight using  upper back muscles. Pause the weight at the chest and slowly lower the weight to the starting position.
• Do not swing  arm to achieve the movement. Remain under control throughout the full range of motion.

Perform desired repetitions on one arm then perform the same number on the opposite arm.

WIDE GRIP PULLEY PRESS :

Fig.2 Wide grip pulley press

Wide grip pulley press:
This is a resistance exercise for building strength and muscle mass of upper back and shoulders.
Sit on a stool with back straight and hold bar of pulley with more than twice width of shoulders. Breathe in and bring the bar down to your nipple level and breathe out and let it go up again. Do 10 repetitions and three sets of 10 repetitions. Same exercise can be done with a pair of dumbbells also.

Bhujangasana (Cobra Pose)

This posture promotes flexibility in the spine and encourages the chest to open.
This asana helps to:

• Strengthens the spine
• Stretches chest and lungs, shoulders, and abdomen
• Firms the buttocks
• Stimulates abdominal organs
• Helps relieve stress and fatigue
• Opens the heart and lungs

Don't do this asana if you have any of the following:

• Back injury
• Carpal tunnel syndrome
• Headache
• Pregnancy

STEPS:

1. Lie prone on the floor. Stretch your legs back, tops of the feet on the floor. Spread your hands on the floor under your shoulders. Hug the elbows back into your body.
2. Press the tops of the feet and thighs and the pubis firmly into the floor.
3. On an inhalation, begin to straighten the arms to lift the chest off the floor, going only to the height at which you can maintain a connection through your pubis to your legs. Better not to rise above the navel level. Press the tailbone toward the pubis and lift the pubis toward the navel. Narrow the hip points. Firm but don't harden the buttocks.
4. Firm the shoulder blades against the back, puffing the side ribs forward. Lift through the top of the sternum but avoid pushing the front ribs forward, which only hardens the lower back. Distribute the backbend evenly throughout the entire spine.
5. Hold the pose anywhere from 15 to 30 seconds, breathing easily. Release back to the floor with an exhalation

If you do abdominal crunches and pull your belly button in even then your back muscles would be strengthened.

Again remember it  is very important to strengthen our central supports that means our back muscles and our abdominal muscles as they support our body and our limbs. So please ,don't neglect the.

Keep on exercising till I send you some more tips to stay fit and young !