Orthopedic Surgeon Dr Santhosh: Importance of Exercise, Muscle Mass, Lower Back Pain & Obesity Risks

The Importance and Risks of Exercise

[00:00] Exercise has been spoken of as something which can be done very easily. I am a sports surgeon. Ask me. Exercise is very dangerous if you... Most of the people who get injured, who are young, have the mindset 3 months. Like...

[00:20] The beauty about muscle is it can be stimulated to grow at any age. You either choose at 45, I'll get arthritis, low back pain or choose to work out exercise. You will get some injuries. One tip that you should tell the audience, I'm going to be very honest.

[00:40] mantra is. Welcome to another session of our podcast Gut Pailing with Dr. Pal. I have a special guest today. His name is Dr. Santosh Jacob. He is physically fit and you will not believe he is only 43 years old. I wanted my audience to learn from him.

[01:00] let me tell you my entire story. I was an obese child, I stopped eating, I used to like to drink, I was a diabetic, I am well controlled now just with exercise and lifestyle modification. Muscle mass also has a diabetes. Absolutely. There is no single disease

[01:20] in the world where having muscle mass is a disadvantage. From Monday to Friday, you're busy with work. Friday to Sunday, you're busy with your social activity. So that takes precedence over exercise. Is there a weight gain as a reason for the low back pain also? So I'm going

Muscle Mass and Its Role in Health & Aging

[01:40] to be very brutal. You are going to have low backache at some point of time because don't be afraid of injuries. Be afraid of not being able to cook your own food if God gives you the life of a 90 or a 100 year old.

[02:00] Hello, sir. Hi. How are you? I am fine. What about you? So good to see you in person, sir. Same here. So you are my inspiration for fitness. Thank you very much. You are my inspiration for Instagram, social media and the amount of hard work that

[02:20] you do to make sure the information is spreading to the mass is nothing but commendable. Thank you. As a fellow creator, I know how much amount of time that you put in. Yes. And it is not easy. It is not easy at all. Do you think doctors should be on social media? It is a very low

[02:40] it question. But if you are a doctor and you have an ability to communicate things which are extremely complex into simple things and you really enjoy it, I think you should. And also there is another advantage

[03:00] advantage of being a doctor in social media. That is, people will always choose more credible sources than lesser credible sources. Human nature is like that. The reason why today there is a lot of misinformation.

[03:20] I am not saying that we never give information which is wrong, see, but at least we have a resource which we follow, a hierarchy of evidence which we follow. And just because of that more doctor

[03:40] Others have to be on social media. Absolutely. And you know, you are an inspiration to many people because similar to me, you were big before, correct? Yes, I was. Around, you look so young, but you know, can you tell the audience how young are you? Yeah, I am 43, going to be 44. Wow.

Dr. Santosh Jacob's Fitness Journey: From Obesity to Strength

[04:00] just two days ago, I made a reel with a stand-up comedian called Vikram where he comes in and says, I want to be just like you at your age at 67. How would you look so young? That's why I said I'm 43.

[04:20] So, when did this fitness journey start in your life? This fitness journey, so let me tell you my entire story. I was an obese child. I was quite physically active till I was 14 or 15. So, I was 6 feet tall and 95

[04:40] kilos when I was in my 10th standard. But I stopped sporting activity because of 11th and 12th education, just like anybody. And by the time I joined medical college, I had gained 2 inches in those 2 years, but I had gained 55 kilos.

[05:00] Yeah, so I was 150 kilos. I very clearly remember Ramachandra Medical College physical examination. I go stand on the weighing machine. The maximum is 150 kilos. It shows ERR. Error.

[05:20] Yeah, so they put it as 150 kilos and from there in the first year I lost around 55 kilos but I did it completely in an unscientific and illiterate manner.

[05:40] I stopped eating completely, went on long fasts. At what age? This was 18. 18. First year, second year of medical college. Then what happened is I lost weight, but I also developed gallstones. I see.

[06:00] I had a few acute episodes. One of the episodes was, so I have a huge scar. That's the scar on my abdomen. If you see, people ask me on your video, have you donated a liver? I said, no, no, I haven't donated a liver.

[06:20] It is a gallbladder removal site. And then you put on weight again or how did this? Yeah, so I never went back to 150 kilos though, but I was looming in at 115 to 120 kilos. That should be a wake up call. Yeah, the wake up call was

[06:40] when I learnt that my son was conceived when I was 39. So, that was like, it is very clear. So, when you have been given a second chance in life and you still behave like you have not got it,

Breaking Unhealthy Habits and Developing a Workout Routine

[07:00] No one can help you. Nothing can help you. So, that is when I started and it has been four years now. This is my fifth year, 2019 I started. Now it is 2024. Where did

[07:20] you start, diet or exercise? I started by exercise. So, see the mantra is, I am going to be very honest. I used to like to drink. So, Fridays, Saturdays, Sundays. Just like Fridays only with some friends, Saturday was a party.

[07:40] Sunday was brunch buffet with my wife. So, this was the routine. And as a result, I was sleeping late on the weekends and I did not realize that that was one

[08:00] of the major reasons why I was unable to exercise in a consistent manner. Because from Monday to Friday, you are busy with work. Friday to Sunday, you are busy with your social activities. So, that takes precedence.

[08:20] over exercise. And so, the one simple principle which I practiced was I consciously told myself that I would not focus on reducing my eating or my drinking.

[08:40] consciously that I won't fixate on that, but rather include a lot of exercise and sport. So, I started by hiring a boxing coach called Coach Madhi.

[09:00] So, I started off my fitness journey. Because you like boxing or just a... I found it extremely interesting. I see. And also I had, I like MMA, watching the sport. So, I thought it would be a good sport. So, it is non-contact.

[09:20] not going to go and punch anybody regularly because as a surgeon my fingers are important also. But with all the protection it is great. So I started off by including exercise, sporting activity in this. What happened was as Saturdays I started to have

[09:40] a class, I started to really miss the class or I was upset if I had to cancel. So, I realized that when you drink or overeat and you have the surge of dopamine, right,

[10:00] You are borrowing from the next day's happiness. You know, you just take some from the next day, you feel happy now. So, when I wanted to play sport, I was able to after a while not

[10:20] not reduce drinking, not give up drinking, but I reduced it. Only three drinks today, two drinks today, one drink today, Fridays in 18 months, I never used to drink. Then Sundays went out of the picture. Then

Structuring an Effective Exercise Plan: HIIT, Boxing, and Strength Training

[10:40] Saturdays slowly started to go out. Now it is like alternate Saturdays with a couple of friends and I am very happy with that because that does not affect my everyday exercise routine at all. So, when do you exercise in the morning or you have to come? So, because of

[11:00] of my schedule, I divide it into 12 exercise sessions. So, it can be just a walk, it can be a run, it can be a sprint, it can be strength training, it can be MMA or boxing. So, whatever I can,

[11:20] Research is very clear that whenever you exercise at a heart rate higher than your normal for more than 9 minutes, benefits are seen. So, I can have like a minimum of 20 minutes if I decide. So, my smallest exercise

[11:40] session will be 20 minutes. On Sundays I do physical activity which lasts up to two and a half hours to three hours. Seriously? Yeah. Sundays I reserve to be like completely physical. Wow. I walk like seven

[12:00] to 10 kilometers, I run, run on the beach and then lift weights, play cricket at least for 3 hours on Sundays. So, that really, really charges me up for Monday because if you exhort

[12:20] cost yourself on a Sunday. You are out by 8 pm and you really sleep well. Monday you wake up, exercise, you are all set for the job. Wow. And then in the remaining days you work for 20 minutes, it is like you know, HAT. Yeah, mostly it will be HIIT.

[12:40] So, boxing is actually a combination of upper body, lower body, your core, your mind, hand-eye coordination and it is 20 minutes is perfect for shadow boxing or back boxing. 90 seconds.

[13:00] what, 60 seconds of break, 90 seconds, 15 minutes you are exhausted, then you just increase your rest by 90 seconds and 20 minutes you have an amazing session. Sprinting, 50 meters

[13:20] Full speed, 50 meters, walk back. 10 sets. Takes only 14 to 16 minutes. And with all these exercises, you have something known as EPOC. EPOC is oxygen

[13:40] consumption after exercise, how much you continue to burn after you stop exercising with HIIT forms, sprinting or boxing or even HIIT that is increased throughout the day. That gives you more back to the work. Absolutely.

Adapting to Exercise: Neural, Muscular, and Endocrine Benefits

[14:00] Absolutely. End of the day it is moving with efficiency of energy. People who are able to direct their physical activity with precision and efficiency of energy will achieve more.

[14:20] Do more. So, wow. When did you have to start noticing changes in your body? Sir, how long will it take? So, if you are really unfit, you can see changes very fast. So, for the first 18 months, I saw so many changes like from my waist was

[14:40] 42, my weight was 113 or 114, just with some walking and some change of that. I came down to 97, like really, I was like, wow, look at my metabolism. But there from 97, so my, let us talk real number.

[15:00] In my DEXA scan, I was 113 kilos or 14 kilos the first time I took it, but my body fat percentage was 37 percentage, 2019. Come 2023 December, okay, because I did it only then, I have

[15:20] Only 16% body fat now. So, the overall muscle mass, lean mass has increased also. I have above 80% lean mass, which is really above average. Yes, absolutely. And then, so during

[15:40] even for myself. So, when I start working out, I am very scared about injuries and what will happen. You should be. No, see, exercise is a dangerous tool. See, anything which can save your life can also kill you or injure you. See, it is like giving

[16:00] Colonoscope in your hands is different, right? Giving a scalpel in my hands is very different. But if you take that instrument and you attempt to change yourself, it is not going to be very good for you. So, excess

[16:20] Exercise has been spoken of as something which can be done very easily. But I am a sports surgeon, ask me. Exercise is very dangerous if you focus on it short term.

[16:40] Most of the people who get injured, who are young have the mindset, 3 months I want to become like Seebam, 3 months like Sharuka. Whenever you are trying to change yourself in 3 months, you forget the basic

[17:00] basic concept of exercise. We do not exercise to lose weight or to look really big. We exercise so that our body adapts. So, one of the principles of strength and conditioning, which is an extremely important

[17:20] What are the tissues which are adapting? Forget weight loss. You do not exercise for weight loss. You exercise for these five adaptations, neural adaptations to maintain the number of neurons you have in the brain. There is enough research

[17:40] to show that Alzheimer's disease, dementia, reduces. The reason is if you strength train, cerebral representation increases. So, every muscle cell can either have one motor neuron unit or 150.

[18:00] So, when you are constantly exercising, doing harder things, your muscle is asking for more nerves and your brain is activated. So, exercising reduces the death of your brain cells. Second is adaptation of the muscle. Your muscle

[18:20] increases in size. The larger your muscle, the better it can be. The larger the muscle, it is easier for you to become stronger. And also, as you age, muscle mass is a very important indicator of

Why Strength Training is Essential for Longevity

[18:40] anti-aging or your age. Then you have endocrine adaptations, hormones, your hormones. After that is your connective tissue adaptations, your tendons, your ligaments, the tissues which are attached

[19:00] onto the bone. Then you have your cardiac adaptations. How much oxygen you are able to use to do a stressful activity, VO2 max, stuff like that. And the common adaptation of all this is

[19:20] your bones become really strong and as an orthopedic surgeon it is extremely important for me because see women especially are really affected by this. Women are already at a disadvantage right. They are physically smaller. They start off

[19:40] off with lesser muscle mass, they are biologically designed to have more body fat and they do not have as much testosterone as us and the world has somehow drilled into them that lifting a 5 kg weight will make them like Arnold Schwarzenegger.

[20:00] Yeah, I am trying very hard to be like, Adol for a second, nothing is happening. So, women who are quite healthy, their health trajectory changes at around 60 to 70 if they have a fall. And they have a fall

[20:20] only because they flip and fall. Yes, they do not have the neural adaptation, stability, balance in order to do the jobs they were doing in the past because everybody thinks today also there was a patient.

[20:40] 63 year old, 20 years older than me. So, I asked her, do you exercise? She said, I do not exercise, but I do all the work at home. Now, it is way better that you do all the work at home than sit at home.

[21:00] Correct. But that is endurance. It will not increase your strength. As you age, you need strength, bone density, cardiac capacity. Strength for what? Strength to be able to lift. Let me explain. So,

[21:20] So, say if your maximum strength itself at 70 is to be able to stand up and sit down, that is only your maximum strength. So, every time you are standing up.

[21:40] Your heart has to work at its peak because your machinery requires a lot of blood supply. Your one rep max is so less. When you have strength

[22:00] your one rep max will be the ability to lift 100 kilos and stand up. That time in order to walk, your heart will not have to work at all. It will do it at 50 beats per minute.

[22:20] That's why strength is very important. The stronger your muscles are, the executory mechanism is the lesser your heart has to work. So if you understand this right, if you lift weight and you are being strong in your young age, your heart does not have to work that much towards the old age and that

[22:40] help you with the overall body surgery. Yeah. So, yes, the ideal situation is you start off sports, gymnastics at 9 to 14, start some form of strength training from 14 to 18, continue for the rest of your life, that would be

[23:00] ideal. But the beauty about muscle is it can be stimulated to grow at any age. Research also clearly shows that somebody who has not exercised at all, say up to 70, you have not lifted any weights. When you start, you

[23:20] Your muscle responds better than somebody who has been exercising. So, you can be of any age. I make my 92 year old patients start lifting weights after hip surgeries and they are very happy. They are extremely happy.

The Role of Exercise in Preventing Low Back Pain and Knee Issues

[23:40] Also, muscle is an endocrine organ. And so see, all the blood vessels go through muscles. So, when you have a larger muscle mass, I am just completely dumbing this down. If you have a larger muscle mass, glucose

[24:00] has a higher propensity to be stored as glycogen in the muscle rather than as glucose inside the blood vessel. That is how increase of your muscle mass helps control your blood sugar. So, I was a diabetic. I am well

[24:20] controlled now just with exercise and lifestyle modification. Muscle mass also has a diabetes. Absolutely. Significantly. See, there is no single disease in the world where having muscle mass is a disadvantage. Think of it and tell me, just like there is no disease in

[24:40] in the world where having an obese body structure is an advantage. Correct. There is absolutely none. Correct. Correct. Correct. So, muscle mass is like mutual funds, good mutual funds.

[25:00] deposited at a young age, which will give you benefits 20, 30 years. 30 years. So, in your practice, you are seeing a lot of osteoarthritis, knee placement. Is it more common in women that you are seeing? So, my practice is a lot of low back pain. Low back pain. Low back pain.

[25:20] knee pain, shoulder pain, neck pain. That is the common thing. So, I am a preservation surgeon. See, I am trained to do joint replacements. My fellowship is in knee replacement. But when I started to treat my mom for osteoarthritis, I realized

[25:40] one thing, the unsaid fear of surgery in patients. So, my mom is 17, I hope she doesn't, she is around 69, 70, 71. Okay, that's her age. One of the three, one of the three.

[26:00] So, she was okay to suffer with knee pain for 12 to 14 years, till it became that severe that she needed to get operated. So, what I do is, I do a lot of cartilage work. So, the understanding

[26:20] So, understanding is if your knees are already bent, it is a varus deformity and you are obese, you need an e-replacement as it is a mechanical deformity. By chance, your varus is not very significant. Then, growing the cartilage inside, reducing inflammation in the knee.

[26:40] increasing size of your leg muscles, strength of your leg muscles, hip mobility, having a really strong core, back muscles, ankle mobility will really help in knee pain. Everybody thinks that knee pain means the problem is in the knee.

[27:00] No, no, no, no, no. It is like this, if you have a traffic jam at a main junction, most probably the main junction has a lot of traffic police signals and all that. The problem is in a junction ahead or in a junction behind. It is the same thing

[27:20] with the knee. If you are imaging, your X-rays are not really bad, but you have significant pain, then you definitely also have to work on your hip, ankle and your core. You do this and

[27:40] And also everybody asks me for how many days do I exercise till the day you want to use your knee. Because muscle needs to be stressed in order to adapt. Which means every day you have to do something harder than what you did before.

[28:00] previous day so that it can adapt. So, that has to be a continuous process. So, anybody who wants to use exercise to live better has to understand that at some point of time it has to become like brushing your teeth, like a habit, like a habit.

Common Causes of Low Back Pain and Solutions

[28:20] So, in your experience, can you tell us an inspiring story where a patient did exercise and got the pain better or something like that? Oh, like a women 40, 45. Yeah. So, I can share a story of my mom itself. So, when we did her first knee replacement,

[28:40] She was around 111 kilos. Then I just did one knee. The other knee we treated with a combination of bone marrow concentrate, stem cells from there and fat. We gave it intraoschis underneath.

[29:00] the cartilage surface and we also did marrow stimulation to stimulate the growth. Then after the knee replacement when one knee was okay, I had also started to post some diet and all that and I was guiding her. She came from 111 to 91. Now she is

[29:20] able to walk around, play with my son with her grandchildren, which is absolutely fantastic. And right now she is not very keen on replacing the other niece because she is not boring. She is able to manage. See, I would not say that it is perfect.

[29:40] But if she loses another 10 kilos, I think she should be alright. Is there a weight gain as a reason for the low back pain as well, sir, or low back pain? What is the most common cause in your practice? So, I am going to be very brutal. If you are above 6 feet.

[30:00] man or woman and your waist is above 34, you are going to have low back ache. If you are below 6 feet and your waist is above 32, you are going to have low back ache at some point of time because we do not have any bones from the Ziffy sternum on

[30:20] to the pelvis. From here to here. Yes. But we have four layers of muscles there. And these muscles which are called the core have the ability to be as strong as a bone and flexible as a muscle.

[30:40] into this part. Yes, the reason why we get low backache is that when we do some activity, we are not able to maintain intra-abdominal pressure because your core is weak. And so you breathe out in a wrong manner. Say you are lifting something, you bend down,

[31:00] and you lift it up. You do not know to brace, hold your core inside. So, the impact goes on the disc. The disc slightly tears or slightly bulges out. And then what happens? You take rest. When you rest, muscles start to waste.

[31:20] further stress. And when you are in severe pain, you start to eat more, you gain weight. So, if you imagine the skeleton, there is an upper body which ends at the ribs, the lower body starting at the pelvis. In between if you see, there is just five lumbar vertebrae.

[31:40] if you actually take our skeletal system. Because when we were, when we evolved or God created us to be erect, He was smart enough to think they also need to bend. So, let them have a soft

[32:00] middle. That is why L1 to L5 is your back, low back. Yes and it has discs in between. That is why upper back pain is quite rare because we have the rib like a circle here. So, if our core was really strong, really strong, it would be like a bone when we are erect or

[32:20] lifting weights and it would become soft when we are bending down. I see. I see. Is posture also like sitting on the computer, bending down? Absolutely. Absolutely. So, again, posture is involuntary. Involuntary. Yeah. You cannot, yes, you can correct your posture.

[32:40] But depending upon the tone of your muscles and the balance, when you are really not focused on your posture, you either lose it or it maintains. It is called activation of the muscle without voluntary control.

[33:00] unconsciously, we just go slouch. So, do you recommend to just keep a timer or something and then? No, I recommend that you start doing exercises for your core like planks, farmer's carries, carrying wits on the side, good

[33:20] posture, core tucked in, functional core exercises, stuff like that. And they can do that even when they are big or they need to lose weight and then do it. No, they can, everybody has to do it. Everybody who wants to stand erect and also bend down to do stuff has

[33:40] to do it. So, come in the 20 minute period that you are talking about. Yeah and also let me tell you it is not ideal to use your spine to bend down. You have to bend down with your knees. But still I bend down because I need some flexibility of the

Building Strength, Preventing Injuries, and Key Takeaways for a Healthy Life

[34:00] knee of my spine also. So, in case there are a lot of exercises where you bend down, that is a necessary movement. So, in case you have to do that and you should not get an injury, you have

[34:20] to have a strong core and back. What is the treatment for low back pain? What do the people do after losing weight? So the first thing I say is reduce added sugar and reduce any processed foods because it increases your inflammation. See, anybody who's having a lot of added sugar or processed foods

[34:40] Their ESR, CRP, which are the signs of inflammation are more or less always elevated. It is not like really high, but it is always elevated. Next thing is see a physiotherapist. Start yourself on stretches and exercises, basic exercises.

[35:00] for your back, your core, stuff like that. Third, start losing weight. Losing weight is extremely important. Fourth, focus on your sleep. Once you do these four things and also with some medications,

[35:20] massages, stuff like that. See, I have seen a lot of my patients improve by just giving them confidence that it will improve. So, I prefer not to remove the disc

[35:40] without doing a lot of interventions. Every surgeon is trained differently. I was trained in order to wait, focus on losing weight. The reason is that you remove a disc from one level. If they haven't changed their habits, it is going to happen at

[36:00] the next one. Other levels also that is one. Second is removal of the disc. It can be done endoscopically where you do not remove the bone, just the disc. But a microdyskectomy would be removing a part of the bone in order to act

[36:20] access the disc and push the nerve down. So, the back pain is because the nerve is being trapped in the disc? Yeah, back pain is primarily because of inflammation of the disc. Surround it. Sciatica is because of compression of the nerve.

[36:40] coming out from L4, L5, S1. That causes the radiation. So, for six months, you've done your lifestyle modification, weight loss, changed your diet, physio, your regular with exercise and your medications. For six months, if you continue to

[37:00] have pain. Then there are a lot of interventional options. Interventional options are physiological pain blocks. It is a new technique where we treat the pain distal to the source of the pain using injections done under local anesthesia.

[37:20] that is a method. Then we have nerve blocks, median nerve blocks, facet joint injections. There we give PRP, those areas. Then we have intradiscal procedures where we do not open

[37:40] We go inside the disc, remove a part of the disc or we ablate the disc or we inject ozone into the disc, things which shrink the disc. And if all these do not work, then we

[38:00] do an open surgery or an endoscopic discrement. I see. Mr. Vaisal, what are you telling me? It is better to prevent any kind of problem rather than treatment. Absolutely. Absolutely. And it is also better for us to identify what are the habits which cost the

[38:20] low back pain because surgery is an intervention. It is an intervention of the problem caused by certain triggers. It is not an intervention of your habits or your triggers. Everybody should understand. Why did I get low back pain again after surgery? Because

[38:40] The surgery was to intervene a complication caused by your habits that has been removed your habits if they are still the same you are bound to get the same complication at the next weakest point That's why weight loss that's why

[39:00] That is why eat healthy. That is why, see the thing is if you stop eating processed foods and sugars, your craving stops. Yes, slowly. Yeah. Slowly but steadily, but when happens. Yes. Shifting back from back to here. Neck.

[39:20] Yeah. And I think I start having as well my textinic. Yeah. It is a problem. Oh yeah, that is a heavy issue. So, I would recommend all of us now to start neck strengthening exercises as a part of your exercise routine because it is only in the last 15 years

[39:40] that we have started to use the computer and the phone. So, before this, who never gets any neck pain? Restless, boxes, race car drivers, because their necks are super strong.

[40:00] They do exercises in order to increase the thickness of the neck muscles. And like, I haven't seen any wrestlers with neck pain. I'm just thinking because they're very strong. Strong neck pain.

[40:20] very strong, anybody who is just hearing this, Google and see exercises wrestlers do for their neck strength. Exercises Mike Tyson used to do for his neck strength. So, if you have strong muscles again here, your neck is not going to hurt.

[40:40] Or it will hurt very less. See, it has always been way easier for me. See, I am a surgeon and I am a surgeon who is attempting to do minimal access as much as possible. So, the people I am

[41:00] to operate on are people who have lesser muscle mass, lesser bone density. So, when you look down, there is a lot of strain over here. So, saying that if you do daily neck exercises. You will be able to look down without strain onto your joints in the spine. I see. The pain is because this muscle is weak. Yes. I see.

[41:20] I see. Sir, I was trained by a personal trainer. Very good. And then I had an injury and it was very difficult to come back. So, any tips and tricks for that? So, it is in the way you think. You either treat your injuries and postpone your

[41:40] degenerative diseases or be afraid of injuries and have degenerative diseases. Life is very complex. Choose your heart basically. You either choose at 45, I will get arthritis, low back pain or choose to workout exercise. You will get some injuries.

[42:00] But remember this one concept, I will always choose injuries because of a training principle. We always adapt to what we recover from. So, even if it is an injury, if you recover from it, you are going to become stronger.

[42:20] But a degenerative disease, once you get it, you know it is a downhill battle. Injuries are always better to stay young. You might have some pain here, some pain there, unless it is a very bad injury. Again, I am not talking about excitment.

[42:40] Correct, correct. Generally, see the guys at 70 who I want to be like, all of them have had at least 10 to 15 injuries in their life because they have been doing things which was harder every day and it is hard to really maintain

[43:00] gain a balance in that. Some days you might just overdo it, then there goes an injury and you have an injury. Do not be afraid of injuries. Be afraid of not being able to cook your own food if God gives you the life of a 90 or a 100 year old.

[43:20] Don't be afraid of injuries. Be afraid of that. You are going to be the same guy. You are going to be the same guy then. It is a very interesting concept. Yeah, absolutely. See, we are afraid of the wrong things. I am afraid of having an injury. Okay.

[43:40] going to be 90, nobody you helped is going to be around you and you are not going to be able to walk up the steps, which is worse. For me, if you are anything like me, I would take injuries because right now I am strong in

[44:00] enough to adapt, then what can I do other than be really sad and depressed? Correct. So, it was a simple choice for me. I am going to ask a personal question for me. Absolutely. So, my body fat person is 24. Even though I look skinny, I do not think I am healthy. So, I want to

[44:20] reduce that, I am working on that. So, you tell me what are the things that I should do. So, the first thing is remember from 40 to 50, from 20 to 35, we can recover from lots of injuries. From 40 to 50, you can recover from 2 injuries, 50 to 61 injury, after that you should not get injured. I see. So, if

[44:40] So your entire plan now has to be injury prevention. So you will have to, just this simple concept, okay. Strength can be developed at any time. As you are increasing your strength, make sure you are increasing your joint mobility

[45:00] hand flexibility of the soft tissues. It should go hand in hand. If your joint mobility, flexibility are not really good and you are becoming stronger, that is where you get injuries. So, at after 40 when you are training, remember that your

[45:20] Joint movement is as important as your strength. Both are fantastic together. Imagine if you are really strong, but you can only lift 200 kilos, 2 inches. Doesn't really matter. But if you are able to lift 100 kilos through a wider range of motion, that's really important.

[45:40] much better. So, yoga gives that? Yes, yoga does. Yoga gives that and there are also set exercises, mobility exercises, flexibility exercises. So, what I do of my 12 sessions of exercises, 30

[46:00] percent of it is mobility, flexibility. I focus on moving my joints, strengthening them, slow range of motion, full range of motion, sitting in very difficult positions, stuff like that. Then 20 percent of it is speed, agility,

[46:20] quickness, running, jumping. 50 percent of it is, 40 percent of it would be weight training, 10 percent of it would be body weight exercises. I love doing pull-ups. So, I was like, I broke a barrier where now I am able to

[46:40] do more than 12 pull-ups, body weight. I know it's not like elite, but one year ago I was not even able to do one. For me it is elite. To me I can't even do more than 3 or 4 now. It needs a lot of strength on the upper body.

[47:00] It needs, strength is probably there, but your brain should know which are the muscles to activate at the right time, which are the muscles which have to fire in order for you to lift yourself up. When you lift waist, do you listen to music? Yeah. Do you listen to music? Yes.

[47:20] So, I also listen to music. Now I have been also training to work out for the first 30 or 40 percent of the time when I start without music and then when I am feeling a little, I need something. Because they say the mind-bound muscle coordination while you are lifting makes a big difference.

[47:40] Yes, so that is like, say Usain Bolt can worry about running in microseconds. We will first start to run, then we will talk about all that. First let us talk, why we are going there already? Let us get to a muscle mass of say 75%.

[48:00] Then we will talk about all that. So, let us run the session by saying that one tip that you should tell the audience in terms of stress training what we will do. So, the one thing would be remember, in order for you to adapt from a stress, the stress

[48:20] Stress has to be right, rest has to be right and your nutrition has to be right. So, it is not just you taking the effort to exercise or progressively overload yourself, increasing your weights, it also has to be punctuated with adequate

[48:40] recovery and essential nutrition, which means proteins, fiber, antioxidants and carbohydrates as necessary. Of course, fats are also essential, but make sure that the ratio is

[49:00] maintained. Super. Thank you so much, sir. You are welcome. Thank you so much. It was fantastic. Thank you. Thank you.