Lifestyle Challenges in
Post Pandemic Era
Dr. Raka Islam
Medical Officer
Physical Medicine and Rehabilitation Dept.
Shaheed Suhrawardy Medical College Hospital
Introduction
We are living in a planet of virus.
Trillions of Bacteriophage working
inside our body, making our living
possible.
Cont...
Virus is our enemy too. Rhino virus first
affected West Nile inhabitants. Endogenous
retrovirus entered our genome 10 million
years back.
In 21st century, we encountered by SARS,
MARS, Ebola and many more. Death toll is
immense.
Cont...
• We are at the end of a
pandemic COVID-19.
• Till today death in
world is 6.24 millions
• In Bangladesh 29127
Cont...
• Morbidity & Mortality due to COVID-19 found to be strongly
related to comorbidities like DM, HTN, IHD, CKD, COPD
• Most of which can be prevented or controlled by Lifestyle
changes
Cont…
• Metabolic Syndrome is a major & escalating public health issue.
• Urbanization, surplus energy intake, increase obesity and
sedentary life style making it a challenge to mankind.
• It confers 5 fold increase in risk of T2DM, 2 fold risk of CVD, 2 – 4
fold increase risk of Stroke and 2 – 4 fold increase risk of
Myocardial infarction.
Metabolic Syndrome
The Metabolic Syndrome also known as
Syndrome X, Insulin Resistance Syndrome,
Dysmetabolic Syndrome - consists of a
constellation of metabolic abnormalities
that confer increased risk of cardiovascular
disease and diabetes mellitus.
Prevalence in India
Age-standardized
prevalence
rates of MetS were 33.5% overall;
Male 24.9%, Female 42.3%.
Prevalence of Chronic Disease in US
 6 in 10 Americans have a Chronic Disease
 38% of Americans will be diagnosed with
Cancer during their lifetimes
 Half of all Americans have CVD
 1 in 3 have Pre-Diabetes, 90% do NOT
know it
 72% are Overweight or Obese
Metabolic Syndrome
Three of the following:
• Waist Circumference
: ≥90 cm (♂); ≥80 cm (♀) in South Asians
• Fasting Triglyceride level
: > 150 mg/dL
• HDL Cholesterol level
: < 40 mg/dL (♂); < 50 mg/dL (♀)
• Blood Pressure
: > 130 mm systolic or > 85 mm diastolic
• Fasting Plasma Glucose level: ≥ 100 mg/dL
* alternate: Previously diagnosed or on Medication
Waist-Hip Ratio (WHR):
Interpretation:
 High Risk WHR:> 0.80 for Females
> 0.95 for Males
Waist
 Indicates central (upper body) obesity and is
considered high risk for diabetes & CVS disorders.
Hip
WHR = Waist/ Hip
 A WHR below these cut-off levels is considered low risk
Hip
Waist-Hip Ratio Standards for Men & Women
Body Shapes :: Apple & Pear
Carry more weight around Abdomen
Carry more weight around Hip
People having Metabolic Syndrome,
typically have Apple-shaped bodies.
Clinical Features
Typically not associated with Symptoms.
Elevated
WHR & BP
??
CVD
T2DM
-NAFLD
-HyperUricemia
-Obstructive Sleep
Apnea
-Polycystic Ovary
Syndrome**
Risk Factors & Consequences
Fatty Liver Disease
Overweight/ Obesity
Hypertension
Sedentary Lifestyle
Ageing
Diabetes Mellitus
Cardiovascular Disease
Lipodystrophy
Metabolic
Syndrome
Cancer
Dementia
Heart Disease
Polycystic Ovary
Laboratory Tests
• Fasting lipids and glucose
• apoB
• hsCRP
• Fibrinogen
• Uric acid
• Urinary albumin/creatinine
ratio
• Liver function
• Testosterone
• Luteinizing hormone
• Follicle-stimulating hormone
• A sleep study
Management
• The foundations of MetS management are essentially
lifestyle modifications, like changes in dietary and exercise
habits
• Moreover, current evidence supports that diet and exercise,
along with pharmacologic and surgical interventions, may
inhibit the progression of MetS to T2D or CVD
Lifestyle Modification
Lifestyle Modification (contd..)
Lifestyle Challenges
• Obesity
• Handling Stress
• Work-Life balance
• Spirituality
• Diet
• Lifelong commitment to a
• Exercises
• Restoration of Sleep
Healthy Life-Style
Obesity
• Central obesity is the driving force behind the metabolic
syndrome
• Weight reduction is the primary approach
• 5% to 10% weight reduction improves in Insulin Sensitivity
and Metabolic Syndrome
Recommendations for weight loss
• A combination of
• Caloric restriction
• Increased physical activity and
• Behavior modification
Work life balance
• Maximum 40 hours of work per week is healthy
• In our country, We work > 40 hours/ week
Diet Plan:
 Calorie Restriction
 ~ 500-kcal restriction daily = weight
reduction of 1 lb. per week
 Carbohydrate restriction
 High-quality dietary pattern—(Fruits,
Vegetables, Complex whole grains, Lean
poultry, Fish etc)
Many Diet Plans;
should be individualized
Intermittent Fasting
 Various meal timing schedules that cycle between voluntary
fasting and non-fasting over a given period
 Good for Autophagy & Rejuvenation of Health
 Three methods:
Time-restricted feeding
Alternate-day fasting
Periodic fasting
Intermittent Fasting (contd.)
Study shows that intermittent
fasting may help with obesity,
insulin resistance, dyslipidemia,
hypertension, and inflammation
and generally safe.
Physical Activity
• 60–90 min of daily activity is required to achieve modest
weight reduction
• Obese adult is unable to undertake this level of activity, a
significant health benefit will follow from at least 30 min
of moderate-intensity activity - daily
Preparation for Exercises
• Warm-up: consists of 5 – 10 min of aerobic activity
• Activity session: 15 – 30 mins
• Cool-down: similar to the warm-up and should last about 5 – 10 min
Exercises
The mnemonic ‘SAFE’ exercise are recommended:
• Strengthening exercise
• Aerobic exercise
• Flexibility exercises
• Endurance exercises
Strengthening Exercise
• Resistance training increases muscle
strength by making them work against
a weight or force
• Includes using free weights, weight
machines, resistance bands
• Strength training improves the Insulin
resistance and Metabolic syndrome
Aerobic Exercise
• With oxygen
• Aerobic exercise is the type that moves
large muscle groups and causes to breath
more deeply and heart to work harder to
pump blood. Its also called cardiovascular
exercise.
• It improves the health of heart and lungs
Cardio-Pulmonary Rehab
6 Min Walk Test
10 Meter Walk Test
Flexibility (Stretching) Exercise
Flexibility exercises are aimed at
increasing or maintaining range of
motion at joints, also improve tone
in muscles and keep it supple. They
develop better muscular and body
control.
Endurance Exercise
• Low resistance,
exercises
high
repetition
• Examples: Walking, Cycling, Swimming,
or upper extremity ergometry that
involve the use of the large muscle of
the body
Prescription of Exercise
Exercises should be done according to FITT principle.




Frequency
Intensity
Type
Time
:
:
:
:
4 to 6 times/ week
30 to 40 min; 50-60% of target HR
‘SAFE’ exercises
Morning is ideal time
Restoration of Sleep
Handling Stress
Pharmacological Management
• Dyslipidemia
• HTN
• Impaired Fasting Glucose
• Insulin Resistance
Surgical treatment
• Bariatric Surgery (BS) and
• Transcatheter Bariatric Embolotherapy
Outline of Management
Take Home Message
- Prevention is better than Cure
- Adoption of Healthy Lifestyle helps to prevent or manage Metabolic
Syndrome, thus can reduce mortality & morbidity associated with
Covid-19
- Exercises & Cardiopulmonary Rehab are essential components of LongCovid management
- Self-Devotion & Commitment is a must to achieve the Goal
Thank You