Health and Wellness

D R M U m e r Iq b a l
DPT , MS-OMPT*
 Fitness

Fitness or state of being

fit is essential to mental
& physical health.
Both mental and physical
fitness are integral to
maintain a healthy mind
and body.
 Mental Health

It is far more than the absence of the mental illness;

it involves an individual’s
self perception (idea about how kind you are )
a realistic perception of others(objects as they really
are)
and having the ability to meet the demands of daily
living.
 Mental Fitness

 It is the state of mind

involving enjoyments of
one’s social & physical
environment, belief in one’s
creativity and imagination,
and using one’s mental
abilities to the fullest extent
by taking risks, asking
questions, accepting
alternative point of view,
and having openness to
continual growth & change.
 Mental Health Fitness and Wellness

Mental fitness combined with an optimistic life

perspective offers hope for achieving happiness and
good health
Maintaining mental fitness requires Balancing b/w
work and leisure
Maintaining Social contacts
Aims and goals in life.
Adequate diet, sleep and exercise.
 Mental wellness

 Its the ability to "bounce forward" from hardship

 Mental wellness involves handling stressors through
appropriate stress management techniques, such as
relaxation and exercise.
 No standardized tool is available for assessment
 Stress assessments, such as the Holmes and Rahe Social
Readjustment Rating Scale,4 provide valuable information
about an individual's life changes and potential stressors
that could affect mental fitness.
 Physical therapists can play an important role in promoting
mental health through exercise and physiscal activity.
 The Holmes-Rahe Stress Inventory

150 points or less = a relatively low amount of life

change and a low susceptibility to stress-induced
health breakdown
150 to 300 points = 50% chance of health breakdown
in the next 2 years
300 points or more = 80% chance of health
breakdown in the next 2 years,
 according to the Holmes-Rahe statistical prediction
mode
 Physical Fitness

 Physical fitness enables an individual to withstand

physiological stressors and extreme demands on
the body
 Physically fit vs. hypo kinetic (physically inactive
or sedentary).
 Physical fitness is identified by two types of
measures:
1. those taken with the body at rest (metabolic fitness)
2. Performance based measures.
 Metabolic Fitness

 It reflects the health status of physiological systems at rest, such as blood

lipid profiles, blood sugar, resting blood pressure, and insulin levels.

 Skeletal muscle is an extraordinarily plastic tissue, and metabolic fitness

alters rapidly with changing levels of activity.

 When muscles are fit, they use more fat at rest and during exercise.
 The capacity for glucose metabolism is also enhanced in trained muscle.
 Physical activity is required to maintain high metabolic fitness.

 Physical inactivity is a major lifestyle risk factor, especially related to the

metabolic fitness of muscle.
 Lipid Profile

A series of blood tests including

Total cholesterol,
HDL-cholesterol (the "good cholesterol" that can
increase with exercise),
LDL-cholesterol (low density lipoproteins-
cholesterol: the damaging cho­lesterol), and
Triglycerides (another type of fatty mate­rial found in
the blood).
 Cont….

HDL/cholesterol ratios: Dividing the total

cholesterol by the HDL value and multiplying by 100
gives the HDL/cholesterol ratio. The HDL ratio
should be above 25 and preferably in the 30s. An
HDL ratio above 40 diminishes the risk of heart
disease considerably. If, however, the HDL ratio is
below 15, a heart attack is likely.
The triglyceride ratio: should be below 2.0.
Individuals with abnormal lipid levels need a referral
to their physician for appropriate medical
management.
Total cholesterol value /HDL value * 100

40-50 mg/dL (1.0-1.3 mmol/L) for men and between

50-59 mg/dl (1.3-1.5 mmol/L) for women 
 Blood glucose

 The oral glucose tolerance test

(OGTT or GTT, a test sampling
venous blood and used to measure
glucose use over time) helps to
identify individuals with diabetes or
at risk for diabetes.
 Fasting plasma glucose test,
requiring fasting prior to the blood
sampling.
 Healthy persons glucose levels rarely
rise above 140 mg/dL (7.8 mmol/L)
following meals. However, in
persons with increasing impairment
of glucose toler­ance, glucose levels
rises in blood & urine following
meals.
 Blood insulin

 The blood insulin or insulin test measures blood samples for the
amount of circulating insulin, A hormone released from the beta cells of
the pancreas and responsible for regulating blood glucose usage by
surrounding tissue.

 Normal values are 5 to 20 micro units per milliliter while fasting.

 Lower than normal values suggest diabetes mellitus, type 1 or 2, and

elevated above normal levels suggest possible diabetes mellitus type 2,
obesity (sec­ondary to the insulin resistance syndrome),
 Pulse Rate

 The pulse rate is the number of throbbing sensa­tions felt over a

peripheral artery when the heart beats.
 This rate normally ranges from 60 to 100 pulses per minute
 Regular rhythms or pulse sensations may be counted for 30 seconds
and multiplied by 2 for a 1-minute pulse rate. The quality of the pulse is
reflected in pulse strength.
 resting position, supine or sitting
 Lack of Pedal pulse….PAD (peripheral arterial disease)
 Bruit (high pitch sound during auscultation of vessels) suggests
possible vascular problems, such as an aneurysm, arterio-venous
fistula, or stenosis, and indicates the need for referral
To check your pulse at your wrist, place two
fingers between the bone and the tendon over
your radial artery — which is located on the
thumb side of your wrist. When you feel
your pulse, count the number of beats.
 Blood pressure

 120/80
 Pressure measurements
include systolic, diastolic,
and pulse pressure.
 Systolic & diastolic blood
pressure
 Blood pressure can also be
obtained by palpation or by
doppler (an ultrasound
method of examining blood
vessels).
 Hypotension/hypertension.
 HEALTH-RELATED FITNESS

Also known as physiological fitness generally

associated with a reduced risk of disease.

Components include cardio respiratory fitness,

muscular strength, muscular endurance, flexibility,
and posture.
 Cardiorespiratory Fitness
 Cardiorespiratory fitness is the individual's aerobic capacity to perform
large-muscle, whole-body (gross motor) physical activity of moderate
to high intensity over extended periods. it is important for the
prevention of heart disease and metabolic syndrome

 It is assessed by a variety of measures Examining oxygen utilization

and endurance while performing functional movement such as walking
and running.
 VO2 Max is the maximal oxygen uptake or the maximum volume of
oxygen that can be utilized in one minute during maximal or exhaustive
exercise.
 It is measured as milliliters of oxygen used in one minute per kilogram
of body weight .
 It is generally considered the best indicator of cardio respiratory
endurance and aerobic fitness
.
One MET is the ratio of metabolic rate (and
therefore the rate of energy consumption) during a
specific physical activity to a reference rate of
metabolic rate at rest.
One MET (metabolic equivalent)= approx 3.5 mg
of oxygen consumed per minute per kg of body
weight.
 Cont….

Respiratory reserve (VO2 R) is the difference

between the max O2 uptake and resting O2 uptake
(VO2 max - VO2 resting).
When testing an individual during exercise, the
examiner can gauge the individual's perception of the
physical effort needed to perform the activity by
using ratings of perceived exertion (RPE).
The Rockport 1-mile walk test,
 the YMCA 3-minute step test can be used to
determine functional cardiovascular fitness endur­
ance.
 Cont….

It is important to measure an individual's resting

and maximum heart rate to know safe ranges of
exercise.
Maximum heart rate equals 220 minus the
individual's age (in years) and is reported as HRmax
(in beats per minute [bpm]).
Resting heart rate is the individual's lowest heart
rate, measured at rest.
 Target heart rate

Heart rate reserve=HRmax-HRrest

Target HR=60-75% of HRR+RHR

 Muscular strength

 Muscular strength is the ability of muscles to produce force at high

intensities over short periods.

 Manual muscle testing (MMT)

 Hand-held dynamometry
 The one-repetition maximum strength test (1-RM) is a popular
method of measuring muscle strength. This test provides a measure of
the maximal force an individual can lift with one repetition.
 The push-up test :triceps and latissimus dorsi muscles.
 Sarcopenia, or age-related loss of muscle mass, can be prevented with
regular exercise
 Muscular Endurance

 Examining the ability of muscles to repeatedly contract

over time. All of the muscle strength assessments with
repeated muscular contractions include a muscle
endurance component and can be used to determine
muscular endurance.
 Flexibility

 Flexibility is the ability to move muscles and joints (including soft

tissue) through their Full range of motion.
 Limited spinal flexibility can lead to functional limitations that impair
independent living, such as functional reaching and maintaining
balance.
 The sit and reach test is commonly used to measure the overall
flexibility of the body
 Goniometer & "end-feels" .
 Older adults tend to be less flexible.
 Pregnant women tend to be more lax.
 Men tend to be less flexible.
Goniometer
 Posture

 Posture is the maintenance

of correct alignment of body
parts.
Poor
Good
Correct
 Poor postural habits
commonly lead to body mal-
alignment and chronic
musculoskeletal problems,
such as low back pain.
 Cont….

Body composition is often represented as two

components: lean body weight and fat weight.
National Institute of Health (NIH) uses the body
mass index (BMI) to define normal weight,
overweight, and obesity since it correlates strongly
(in adults) with the total body fat content.
% body fat = (fat weight / total body weight) x
100).
Body Composition
 Cont…..

Skinfold thickness measurements

BMI is a key index for relating a person's body weight
to height. The BMI is a person's weight in kilograms
divided by their height in meters (m) squared.
When combining BMI with waist measurements, the
health professional can determine an individual's risk
for disease, particularly cardiac pathology
Waist to hip ratio is simply measured using a tape
measure around the waist and largest circumference
of the hips. The ratio is a simple calculation of the
waist girth divided by the hip girth.
 Cont….

Girth measurements and body breadth

measurements are additional measures of the body's
size and shape.
Hydrostatic weighing has been called the "gold
standard" for measuring body composition.
 SKILL-RELATED OR MOTOR FITNESS

Postural Balance
Reaction Time
Power
Speed
Agility
 Postural balance

Postural balance, or equilibrium, can be described as

the body's ability to maintain an intended position
(static balance) or progress through various move­
ments without losing postural control (dynamic bal­
ance).
one-legged stance test (OLST)
sharpened Romberg test (SR)
The Berg balance scale, a standardized scale, is a 14-
item test that focuses on reaching, bending,
transferring, standing, rising, and other func­tional
tasks for a total of 56 points.
 Cont…..

 The functional reach test measures the difference in

inches between a person's arm position at rest (with the
shoulder flexed to 90 degrees) and the distance reached
forward while maintaining a fixed base of support while
standing.
 The Tinetti balance test of the performance-oriented
assessment of mobility problems consists of 28 items related
to balance while standing and moving.
 The timed up and go test is a balance test that measures
the time needed to rise to standing from a chair, walk three
meters, turn, walk back to the chair, and sit down.
 Coordination

Coordination is harmonious movement, reflecting

the coordination of muscle contractions and their
timing for desired movement.
The finger-to-nose test
dysdiadokokinesis test or rapidly alternating
movements test
sliding the heel down the shin
 Reaction Time

Reaction time is the amount of time needed to

produce movement in response to a stimulus.

The ruler test, a quick and readily available test for

reaction time, measures the response when a ruler is
dropped over the individual's head. The aim is to
catch the ruler before it drops past onto the floor.
 Power

 Power is the ability to generate force (measured in force

units/time units [ie, watts])
 Power is important for lifting objects and pushing objects,
as observed in competitive football and weight lifting.
 The individual is asked to perform two consecutive 6-
minute bicycle ergometer rides with work loads selected to
produce a heart rate between 120 and 140 bpm on the first
session and between 150 and 170 bpm on the second
session. For each session, the average heart rate (bpm) and
power output (watts) are recorded.
 Speed

Speed is the rate of movement and is essential for

performing daily activities in a timely manner.
60-meter speed test, assessing gross motor speed for
normal or athletic populations.
THANK YOU