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Health&Fitness Heart health, breast screening, brain training and more inside


Issue No. 3 • september 2012

Ella Camilleri epitome of elegance Work towards a coregasm Banish the darkness Addressing negative emotions

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September 2012 News

he temperatures have started to drop, offering a little respite from the heat but also signalling the end of bikini season. Use the cooler weather as motivation to step up your exercise routine and improve your performance rather than take the easy way out and

cover up. Ballerina, Ella Camilleri talks about the discipline and determination she learned from ballet that has given her the ability to succeed, both on and off the stage. Mariella Dimech talks about the trouble of burying negative emotions. Though dealing with negative situations may disrupt the balance of a relationship in the short term, she says avoiding them will render the relationship unsustainable. Lacking motivation to get in the gym? Don Pisani talks about new research that has proved the urban myth that women can actually achieve an orgasm while working out – whether doing abdominal training, climbing ropes or cycling – the “coregasm” is now being accepted in the scientific community. Whether working out or eating right, taking your body type into consideration is an important part of achieving your weightloss goals. Daniel Petre tackles the two most common body types, big bums and big tummies. After bikini season, when time for recovery may be more realistic, many will go down the surgical route to get the body they are looking for. Ray De Bono cautions people on the reasons they choose to go under the knife and advises them how to go about it in a safe manner. We hope you enjoy this issue of Health and Fitness Today and look forward to your comments and questions.

3 Check out the latest in health news

INTERVIEW 5 Ella Camilleri is the perfect picture of elegance

Sexual health 11 Dealing with erectile dysfunction before popping pills

Mental health 15 Banishing the dark thoughts by meeting them head on

Physiotherapy 18 Injury through excessive comfort – get off that backrest


Stay strong,

20 Mythbusting – the “coregasm” 22 Richard Geres brings out the Kettlebells 25 Brain training for successful life changes

Nutrition 27 Substitute carbs with whole grains 28 Eat and workout for your body type

Cosmetic surgery 36 Safety in cosmetic surgery


Anti-inflamatory foods


Kid’s health

Safety in plastic surgery

38 Keeping the little ones safe in the car

Radiotherapy 41 Malta’s breast screening programme


Coregasm in the gym


Matthew Bartolo Raymond DeBono Sex counsellor Cosmetic surgeon

Mariella Dimech Richard Geres Carlo Conti Psychotherapist Fitness instructor Physiotherapist



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Vjal ir-Riħan, San Ġwann SGN 9016 Malta Tel: +356 382741 • Fax: +356 21381992

Daniel Petre Nutritionist

Kevin S. Ferriggi John Xuereb Don Pisani Fitness instructor Fitness instructor Entrepreneur

Managing Editor: Saviour Balzan Editor: Rachel Zammit Cutajar Cover photo: Ella Camilleri

Charmaine Gauci Director for Health Promotion

Sylvana Brannon Childbirth educator

Design: Kevin Grech Cover photo by: Ray Attard Head of sales: Adriana Farrugia Contact for advertising: Ray Falzon – 21382741 ext: 118

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New research warns that fathers over 40 may pass on more genetic mutations to their offspring. Though traditionally it was thought that the age of the mother generally affects the health of the baby a new paper published in Nature said that genetic mutations responsible for conditions such as autism and schizophrenia may come from sperm from older fathers. The study included 78 trios of mum, dad and baby and found that fathers passed on nearly four times as many mutations to their children as mothers. A 36-year-old man passed on twice as many mutations as a man of 20. This is because a sperm cell constantly divides and this provides more opportunity for genetic errors to creep in each time the cell splits its genetic material. The average age of new fathers is

increasing. 25% of new fathers were between the ages of 35 and 54 in 1993 whereas this rose to 40% in just a decade. Other studies show a link between ageing fathers and other rare genetic conditions such as achondroplasia (short limb dwarfism), cleft lips and palate, retinoblastomas (childhood cancer of the eye) and other illnesses later on in life such as breast and prostate cancer. The Malaysian Mental Health Survey found people whose fathers were at least 11 years older than their mothers had an increased risk of anxiety, depression and obsessive-compulsive disorders. Studies so far have only shown associations between age and genetic mutations and the above conditions may be caused by a variety of factors and the evidence is not strong enough to start testing babies of older fathers.

Coconut oil could combat tooth decay

Scientists have found that coconut oil, that had been treated with enzymes, stops the growth of streptococcus bacteria, which causes tooth decay. The research team from Athlone Institute of Technology in Ireland tested the impact of coconut oil, vegetable oil and olive oil in their natural states and when treated with enzymes in a process similar to digestion. The enzyme treated coconut oil showed an ability to inhibit the growth of most strains of the bacteria Streptococcus in the mouth which is the leading cause of tooth decay. It is thought that the breaking down of the fatty coconut oil by the enzymes turns it into acids which are effective against bacteria. The oil can be used as an active ingredient in dental care products as an alternative to chemical additives.


Older fathers pass on mutations to their children

Organic food ‘no healthier’ Researchers at Stanford University have found that eating organic food will not make you any healthier though it could cut exposure to pesticides. More than 200 studies were analysed and no discernable health benefits were found in those consuming organic foods as opposed to nonorganic foods, though they contained up to 30% less pesticides. Researchers analysed 17 studies that compared people who consumed organic food and people who consumed conventional food produce as well as 223 papers that looked at the nutrient, bacteria, fungus and pesticide levels in various foods including fruits, vegetables, grains, meats, milk and eggs. The results, published in the Annals of Internal Medicine found that fruit and vegetables had the same amount of vitamins and milk had the same amount of protein and fat. None of the studies ran longer than two years making the long-term benefits of consuming organic foods impossible to determine.

Help or hype? There is research out there that can tell you whatever you want to hear. In the words of Mark Twain, “there are lies, damn lies and statistics”. So how do you make heads or tails of what is out there?

Where has the research been conducted?

Some research centres have stricter research criteria than others. Look at which university the research has come from and decide how reliable the data are.

Has the research been published by a peer-reviewed journal?

Good research is published in peer-reviewed journals, meaning professionals working within the same industry decide whether research methodology and subsequent results are reliable enough to be published.

Has the research been conducted on humans or animals?

In preliminary stages, research will be conducted on animals and only when there is evidence that there is a link between two factors will human trials begin. Though humans and animals may have the same reactions, it is not foolproof evidence unless the sample contains people.

How large is the sample?

The larger the sample the more reliable the results. If two people out of four got slimmer watching exercise programmes on TV doesn’t mean this is fact. A number of other factors come into play, the effect of which will be eliminated if the sample is big enough.

Health & Fitness Today • September 2012 - 3

Classical ballet immediately brings to mind images of long hours of training, blistered feet and near starvation to achieve grace of movement that seems to defy gravity. Ballerina Ella Camilleri talks to Rachel Zammit Cutajar about the discipline of ballet, fuelled by passion for the art, which has helped her achieve beyond the world of dancing.


The epitome of elegance



s Ella walks into the studio, it is immediately clear she has done ballet throughout her life – impeccable posture and grace that now is second nature to someone who has spent so many hours tuning her body. Daughter of the ballet school principal, Brigitte Gauci Borda, ballet was naturally a part of Ella’s life right from the beginning. “I was never forced into it. While I was still in nappies I spent a lot of time at the studios with my mother and I always wanted to dance. My older cousins who were already enrolled in classes would take my hand and show me some of the things they had learned until I was old enough to start classes by

6 - Health & Fitness Today • September 2012

myself. “I love the atmosphere at the ballet school, whether I am working towards a ballet exam or rehearsing for a performance. The sound of classical music drifting from the studios, dancers coming and going and the young children aspiring to be ballerinas, make me feel right at home.”

Usually when teenagers reach O-level stage, they cut down or give up their ballet classes. The pressures of school exams seem to take over and for some students classical ballet becomes too demanding so they might give it up for an easier dance discipline. “The school offers jazz, hip hop, contemporary and Spanish classes, but I always managed to keep up my ballet. I think its all about time management, if students manage their time well, there should be no reason to cut down or stop ballet lessons. “It’s a real shame that dance students stop ballet or switch to

less demanding dance disciplines, they usually regret it and some eventually try to take up ballet again. It is easy for a ballet student to do other forms of dance, but it is very difficult for students to come back to ballet successfully. “I have tried other dance styles such as lyrical jazz, contemporary

INTERVIEW and hip hop which are great fun, but ballet will always remain my favourite discipline.” Even throughout university Ella kept up the dancing, taking her books to the studio to try and squeeze some studying before and after ballet classes. “My final year at university was tough. I had lectures that finished at 8:00pm so couldn`t always make it to my ballet lessons. I kept it up as best I could, sometimes taking classes of a different level, not to stop my training. “Muscles start to weaken and stamina decreases after just a few weeks and it then becomes a struggle to maintain height of leg, jumps and flexibility, not to mention the muscle pain that follows the next dance session”. Every ballet dancer needs to have a lean physique and there are whispers of anorexic dancers hurting themselves to achieve the figures required by ballet masters. “Definitely not at our dance school. Senior students dance three to four times a week and without the right diet it is impossible to perform well. There have been days when I was so busy I didn’t have time to eat and at the end of the day my performance really suffers, so from a personal perspective I make sure I eat well. “The school also takes this very seriously and encourages students to have a balanced healthy diet. If dancers are too thin or too pale, the issue is discussed immediately and at length.” The discipline of regular dancing has paid off with Ella who has been attending international summer dance schools abroad from the tender age of 10, and being selected to dance in some of the Brigitte Gauci Borda’s spectacular performances. “Although I am the principal’s daughter there is never any preferential treatment given to me, for that reason and I have to work just as hard as everyone else to get where I want to be.”

Brigitte Gauci Borda school of Dance celebrated 20 years with the ballet Swan Lake which was held at MCC in Valletta, with principal guest dancers from Russia and Japan and soloists from the UK International choreographer Terence Etheridge and ballet mistress Sianne Strasberg from Duchy Ballet auditioned the students and cast their parts. Ella was chosen to be one of the 32 swans, every ballet dancer`s dream, she was also chosen to dance as a soloist in Act 3, of this famous ballet, a part she was awarded completely on merit. Ella had the opportunity to attend various summer schools throughout Europe including The College of Cornwall, UK, Ballet West, in Scotland and more recently Pineapple Studios in Covent Garden in London. “It’s great to be able to dance with a number of international teachers. A teacher might give you the same correction over and over again for years, then suddenly a guest teacher gives you the same correction and it finally registers and all falls into place. “Although we have a number of international professional dancers and teachers coming to Brigitte Gauci Borda School of Dance, its always a great experience to be able to travel to a dance course abroad. The Pineapple experience was fantastic. We danced four and a half hours a day, with shopping and sight seeing in between classes and West End shows in the evening– six days of living and breathing dance and theatre.” For Ella, the discipline of ballet extends beyond the studio. She recently graduated from the University of Malta, placing first in her year, with a First Class degree in Banking and Finance. She was also awarded the Dean’s Award for her distinguished performance. She is currently en route to The University of Bath to do a Masters Degree in Finance. Though the fields of finance

Senior dancers dance three to four times a week and without the right diet is impossible to perform well and ballet are very different Ella does not see why it is impossible to do both. “A career of a ballet dancer is limited in Malta and there is no reason one cannot do both. I need variety in my life and nothing is impossible with a little bit of determination and dedication. “On the other hand I have no intention of giving up dancing over finance. When choosing a university, I first selected the universities that were ranked highest for the course I wanted to do, then I did a bit of research to find out which universities offered ballet classes. The University of Bath offers dance classes in classical ballet and other dance disciplines and is very active with dance performances and competitions. “I’m especially looking forward to the ballet competitions that take place in the UK. Though there have been dance competitions in Malta

they have traditionally been in ballroom, Latin, hip hop, jazz and not classical ballet, so I’m looking forward to trying something new.” Ella’s interests are not limited to the dance studio. She loves to ski and goes on an annual skiing holiday with the family and friends. “For me and my family a skiing holiday is about the skiing, no late nights drinking, or long lazy lunches on the mountains. We make it a point to be in bed by 10pm, up early for breakfast, first in line for the chair lifts and ski for a full day, till the chair lifts close.” Besides skiing Ella also enjoys modelling and has modelled for various magazines and fashion shows. She also loves to travel and wants to spend some time doing volunteer work in developing countries, however she is trying not to do too much planning and just take things as they come. “In the past I have always been a compulsive planner, trying to plan what I will be doing in 10 years time. I’m slowly learning that opportunities come when you least expect them and that situations change. There is a right time and place for everything, so I’m trying to stick to planning for no further than a year. This year, I will be working towards my Masters Degree and after that, who knows what might come my way!”

Health & Fitness Today • September 2012 - 7


60 seconds with Ella Camilleri Date of birth: 6 December 1990 Born in: Malta Profession: Student at University of Bath doing a Masters Degree in Finance Loves: Classical ballet and all dance styles When not dancing: Skiing, travelling and meeting friends Favourite music: Commercial Favourite movies: Don’t really have a favourite, but I enjoy thrillers and the occasional documentary Last book she read: Text books. After spending so much time studying I need a bit of a break from the written word!

Health & Fitness Today • September 2012 - 9

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sexual health

Get it up without the little blue pill – dealing with erectile dysfunction A limp penis is no longer the problem it used to be thanks to the little blue pill that has had middle-aged men rearing to go since 1998. However erectile dysfunction may be the result of a more serious problem, possibly marking early signals of cardiovascular disease or simply being stress related. Getting to the root of the problem is always the preferable course of action so talk to your doctor or therapist about the problem.


eorge, a 50 year old man comes to the clinic with his new partner because he is experiencing erection difficulties. He has heard of a pill that he can take to make it better. I suggest that before he starts popping pills we check other causes. Erectile dysfunction (ED) can be a symptom of other problems and popping a pill might give George an erection but we would only be working on the symptom rather than the problem causing the erection difficulty. First of all, one needs to know that all men will experience erection difficulties at least once in their lifetime and 10% of all men suffer from erectile dysfunction for a prolonged period of time. Recent research also shows that half of men over 40 suffer from some extent of ED. Erectile dysfunction, also known as impotence, is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse. This is a problem that often results in men suffering in silence as most men perceive the problem as a lack of masculinity and virility and tend to avoid confronting the issue and accepting it as their new reality, living with it in secret.

Matthew Bartolo Matthew is a Counsellor by profession. He is currently specialising in Sex and Relationship Psychotherapy at the Porterbrook sex clinic in Sheffield. Matthew works in private practice both in the UK and Malta. He organises weekends and seminars for couples, of all sexual orientations, and ages, who want to rekindle their intimacy.

One also needs to understand that the older a man gets the softer and less erect the penis gets during an erection. I always tell my clients about the 5 finger rule. If you look at a hand with open fingers the thumb, when fully open represents what an erection of a 20 year old should look like, the index finger represents an erection of a 30 year old, which is still erect but slightly lower. The middle finger shows the angle at which an erection of a 40

year old should look like, ring finger an erection of a 50 year old and pinky an erection at 60. There are different causes for ED and if these are tackled, men suffering from this dysfunction can, most likely, gain their erection back. The causes can be categorised into three different groups – psychological, medical and physical.

Physically, one needs to understand that an erection happens because when the man gets excited the penile tissue is filled up with blood. This is what makes the penis grow bigger and harder. In order for this to happen blood needs to flow from the rest of the body into the veins and tissue in the penis and stay there until ejaculation occurs. This is why any physical condition that affects blood flowing through the veins, such as high cholesterol levels, cardiovascular problems, and hormone deficiency will affect erections. As a matter of fact, doctors have identified erectile dysfunction as a “marker” or “early warning sign” of possible cardiovascular diseases. Therefore if you are experiencing erectile dysfunction it is important that you discuss it with your doctor who will be able to carry out checks for

Health & Fitness Today • September 2012 - 11

sexual health cardiovascular disease which might also treat the erectile dysfunction.

In this case I would suggest that George stops smoking, if he does, cuts down on the

Myths 4 “Erectile dysfunction is a sign of lower virility” False. The virility of a man cannot be measured on the basis of the hardness of his erection.

alcohol and unhealthy foods, and starts exercising. This would help him feel better about himself and gets his body in shape again. A more specific exercise for his penis is the vacuum pump which he can use three times a week to help the circulation in his penis. It is important that the vacuum pump is bought from a trustworthy seller and used responsibly as it can also cause problems if not used

4 “You should always have an erection in the morning when you wake up.” False. Although the presence of an erection on waking gives a sign of good functioning of the erectile system, it is normal for men not to have an erection every time they wake up. 4 “Masturbation causes erectile dysfunction.” False. Masturbation is not a cause of erectile dysfunction. 4 “Early ejaculation is a symptom of erectile dysfunction.” False. Early ejaculation (often referred to as premature ejaculation) is not directly associated with erectile dysfunction.

12 - Health & Fitness Today • September 2012

All men will experience erection difficulties at least once in their lifetime and 10% of all men suffer from erectile dysfunction for a prolonged period of time

properly. Surgery to treat many diseases like prostate cancer may cause physical trauma due to damage of the nerves and vascular supply. Damage to the nerves can mean that there might be less sensation in the penis and less signalling to it from the brain – referred to as neuropathy. This in turn makes it more difficult to get and maintain an erection. If you have had pelvic surgery and are experiencing erectile dysfunction, or are concerned about sexual intercourse, it is important that you ask your doctor for help. Another important suggestion would be that George tells his GP or therapist what medication he is currently taking as erection dysfunction could be side effects of some medication. Medication that is notorious to affect erection and sexual drive are anti-depressants and antihypertension tablets. George has a new partner so it could be that he has performance anxiety when being intimate with her. Therefore relaxation tech-

sexual health


finger rule

If your erection is not what it used to be there is no reason to panic as a man’s penis becomes less erect with age. The five finger rule lets you know what is normal for a man within your age bracket. The fingers of an outstretched palm will say something about the normal range of an erection at different stages of life.

Thumb – an erection in your 20s Index finger – an erection in your 30s Middle finger – an erection in your 40s Ring finger – an erection in your 50s Pinky – an erection in your 60s Doctors have identified erectile dysfunction as a “marker” or “early warning sign” of possible cardiovascular diseases

niques and communication exercises might help him feel more at ease in this department. Other relationship issues are also known to affect men’s erection. Opposite to general belief men are affected by relationship issues and if they are not happy in a relationship it might cause for their body to reject the idea of having sex with their partner. Other relational causes known to affect erections are fear of fatherhood, when the man consciously, or sub-consciously is scared of parenthood and therefore his body reacts by not “letting

him have sex”. Other psychological factors that might cause erection problems are stress, both at home and otherwise. It is a basic human function that helps keep the human species as strong as possible. If we are not happy or worried about our life situation we do not feel like having sex. This happens so that we do not procreate unless we are in a stable enough environment to take care of our offspring.

Therefore if we feel depressed, unhappy or anxious we tend to not feel like having sex. Erection problems can be caused by several bigger problems. Take your time to explore other treatments and work on the causes before popping the pill. If George is suffering from a medical or physical problem it would be wiser to repair the damage causing the problem with his erection rather than get-

ting an erection and leaving the causing problem to get worse. If the problem is of a psychological nature once George stops taking the pill he will revert back to suffering from erection difficulties. This is why it is very important to consult a therapist or doctor when you experience erectile dysfunction. For more information contact Matthew Bartolo on

Health & Fitness Today • September 2012 - 13

Addressing negative emotions may upset the balance of harmony in the short-term. However, relationships, whether romantic or otherwise, will not thrive unless emotions are properly dealt with so that similar issues do not arise in the future.


motions, thinking processes, behaviour and actions work together interchangeably and affect many aspects of a person. As a psychotherapist it is not uncommon to work with persons who are overwhelmed with their emotions and who suffer from stomach aches and other psychosomatic effects due to tension and feelings that they cannot begin to define or express. On the other end of the spectrum, there are also many who act impulsively only to later on cringe when they look back and remember their behaviour. Some people act inward and “swallow” their emotions creating little explosions within their body. These “explosions” are often experienced as butterflies, stomach cramps, tension in the neck, back as well as stiffness in other parts of their body. On an even more serious note repressed emotions may also result in ulcers, skin problems, high blood pressure increased incidence of diabetes

Mariella Dimech Mariella is a pychotherapist specialising in addictive personalities. Besides working privately with persons having problems such as depression, anxiety and other emotional issues, she also conducts training within the organisational field focusing on well-being and motivation

and heart disease as well as anxiety and depression. Many people think that if they bury negative, sad or traumatic experiences they are helping themselves, though in reality they are not at all. Research indicates

that suppressing or avoiding emotions actually makes the feelings stronger and the more a person tries to avoid or distract themselves from what they are really feeling, the harder it becomes to face similar situations,

Health & Fitness Today • September 2012 - 15

mental health

Dealing with the darkness within

people or places. For example if you are sad because a friend has hurt your feelings or your partner is quarrelling with you and you want to avoid the sadness, you may go shopping, meet people, watch a movie and try and keep your day as pleasant as possible. However, the sadness and worry is still present at the back of your mind and a small hiccup will trigger off a possible over-reaction to the situation. This will happen even if the “hiccup” has nothing to do with what you are really feeling, your body will still release

pent up emotions. Communication between couples may often become strained if feelings are not shared and empathy shown since swallowing emotions may keep the peace for a short period but will never create a harmonious environment. People do not express themselves in many ways by avoiding the upsetting subject, people, or places, by distracting themselves in various ways or even worse by turning to alcohol, drugs or other addictions. None of these are healthy methods of dealing

Unhealthy methods of avoiding emotions People deal with emotions in different ways, however some methods are unhealthy. Below are some common methods used by many on a regular basis. • • • • • • • • • • • • • • • • • • •

Ignoring your feelings Thinking obsessively over issues outside of you Pretending something hasn’t happened Overeating Eating foods loaded with sugar and fat Excessive drinking of alcohol Excessive use of recreational drugs Not connecting with people close to you Not talking about anything personal Avoiding situations, people or places that may trigger any emotions Exercising compulsively Any type of compulsive behavior Excessive sex with or without a partner Always keeping busy so you can’t feel Constant intellectualizing and analyzing Excessive reading or TV Working excessively Keeping conversations superficial Burying angry emotions under the mask of peace and love

with emotions, and sometimes people do this without realising that they are avoiding unresolved issues that continue to condition them in both their personal and social life. There are also persons who express themselves impulsively and aggressively, often feeling relieved for a short while but not feeling fulfilled in the long term, especially if they fail to understand where their feelings are stemming from. As children we learn that we cannot just express ourselves whenever and however we feel like. A repressed urge is often necessary to maintain harmony in our lives, especially if the behavior would be inappropriate. For example a secretary may choose to repress his romantic feelings for his boss in order to keep his job. However, when painful memories or emotions are not expressed and processed in a healthy manner this may also create anxiety, frustration and even depression. These emotions may be so strong they are still expressed in an unpredictable and often exaggerated way, even though the individual may not understand what is causing such a reaction. Instinctively people who act out impulsively will blame others, the situation or the environment for their actions. However no one can hand over a personal feeling! As adults all feelings need to be owned and acknowledged as coming from within. The backbone of our emotions, thoughts and behaviour is our belief system stemming from childhood. Although there are many elements that will affect

For more information contact Mariella on

Health & Fitness Today • September 2012 - 17

mental health

how we feel and behave, our belief system will have a great impact of how we perceive ourselves and the world around us. For example if an intelligent boy was raised by very critical parents who never encouraged or gave positive reinforcement, then as an adult he may believe that he is unable to achieve and this belief will affect his emotions, thoughts and behaviour throughout his life. In order to understand our emotions it is helpful to first acquire insight into our belief system, not an easy feat since often our beliefs are often perceived as the way things should be, rather than an objective view of what is. The only way to be able to really know what we are feeling and express our emotions is by slowing down and becoming aware of what we are experiencing in the here and now. If you are feeling anxious, tense, any emotion really in an intense manner, stop for a few seconds and become aware of your body. Go south and place your hand on your stomach and breathe gently, do not get caught up in negative thoughts, or you will not be able to really sense what is going on. Just take a few moments and listen to your body, listen to your thoughts and if it helps write them down. Moving too fast will help you avoid distasteful feelings for a while but will only briefly postpone the inevitable negative effects of ignoring your emotions. If a person has repressed emotions the thoughts and behaviour in the present are probably reactions to past events too. If you find that in your everyday life you are experiencing intense emotions and you tend to blame events or people outside of you, then becoming more aware of yourself will help you become mentally and physically healthier. Whether you are suppressing your emotions or whether you are acting explosively you are doing harm to yourself and others. There are three basic steps to dealing with emotions. The first step is slowing down to understand your emotions, second is changing what you can and this may not necessarily mean something always outside of you but maybe the way you perceive a situation and lastly expressing yourself in the healthiest way possible.


Give your back a rest Life in modern times can be navigated from the comfort of the office chair. Though life has become a lot less strenuous the incidence of injury is not on the decrease with back and neck injuries resulting from weak backs, unable to cope with simple every day tasks like typing a shoe lace.


otion is everything. Everything we do in mind and body translates into motion. Thoughts create motion, and emotions translate into action. Being awake or asleep, human beings never cease to move. Through movement, we express our feelings, get jobs done, play and have fun and contribute to shaping the world around us. However with the use of technology we can now accomplish most of our daily tasks from the sitting position. We socialize, commute, dine and study in a seated position. Most of all, a big part of today’s work force gets the job done from sitting 8 to 10 hours a day. One can easily agree that office work carried out in sitting is less physically demanding than manual work. Then why is it that most chronic back pain sufferers come from this sedentary, relatively “non strenuous” work force? All research points towards one predominant factor – our backs are becoming weaker through sheer comfort. The chairs we sit on are valued for their aesthetic appeal first and cushioning comfort second. Chairs that act like sofas on stilts are the epitome of good sitting – or so it is thought. The fact is that the human body and the spine are not impressed nor benefit from these ego-massaging gadgets. For most backs and spines, sitting ergonomics in the majority of today’s offices is poor. Most of us are familiar with the concept of ‘good’ sitting posture – straight neck and back with the hips and knees held at right angles. This kind of sitting posture, also known as Victorian sitting, was based on postural alignment that

Carlo Conti Carlo holds a doctorate in clinical physiotherapy and is a specialist in manual therapy for the management of back pain, neck pain, sitting posture and ergonomics.

was exclusive of soft tissues such as muscles. In reality, this kind of posture is not good at all. Adopting this posture in sitting generates too much muscle activity in the lower back to counterbalance the backward torque created by the hip muscles on the pelvis. Sooner rather than later a person sitting with an overly erect spine will experience fatigue and fall in a slouch. A slouched posture held for extended periods of time not only stresses the spinal discs and lead to spinal joint pain, but it also leads to compensatory hyperextension of the neck as the person tries to maintain a forward gaze. Been suffering from terrible headaches lately, aggravated by prolonged sitting? Now you have a clue where these headaches could be coming from. The second problem arising from sitting in luxurious and comfortable chairs for

18 - Health & Fitness Today • September 2012

prolonged periods of time is muscle weakness. Like all other muscles in the body, the stabilizing muscles of the vertebral column need to be exercised. Sitting in what looks more like a cushionedcast for the spine results with our spinal musculature being rested for 8 hours a day – and another 8 hours at night.

Once this scenario is acknowledged, it is easy to imagine what happens to the muscles that keep our spine upright, stable and healthy. They get weakened, atrophic and lose the ability to keep the spine stable. Have you ever seen an elderly patient get on their feet following three weeks in bed? That’s

exactly how our spines behave following a long period of immobility. This weakening of the spine is what causes so many individuals to injure their back out of the office as they bend down to pick up a pen, do their laces or any other seemingly trivial deed that loads their spine. Luckily, the solution is easy. Research suggests that we should adopt a sitting position that places the hips higher up in relation to the knees. This position will diminish the tension generated in our bottom muscles that force our spine into a slouch. Sitting on the front edge of the seating pan and adopting a neutral lumbar spine in this elevated position, allowing the entire spine up to the neck, to be kept in perfect alignment and with minimal effort. Adopting a neutral lumbar spine is done by rolling the pelvis forward and backwards to the end of range and then locating the mid position of this movement. This sitting position will see us loading our legs more and help us maintain an active

Our backs are becoming weaker through sheer comfort

Back muscles get weakened, atrophic and lose their ability to keep the spine stable trhough inactivity Upright sitting posture as commonly advocated in ergonomic literature, also known as Victorianstyle sitting, is no longer considered the ideal sitting position

back during our day. It is no surprise that when our backs are better-aligned and less prone to discomfort, we will find ourselves focusing more on the quality of our work. A word of caution is that, like all muscles subjected to a new form of exercise, mild discomfort in the supporting muscles of the back is to be expected. The sitting posture being hereby advocated is considered optimal, but one should start adopting it in half-hour increments per day. Once the muscles of the back adapt and become stronger, the stability of the spine is maintained in both sitting and, more importantly, when we’re out there having fun.

Ideal sitting posture: Neutral Lumbar Spine

Finding the Neutral Lumbar Spine. Start by adopting a slouched ‘posteriorly rotated’ pelvis. Then arch your back into maximum extension. After repeated this bottom rolling for 2-3 times, try to locate the mid-position. This will set your spine in neutral for the particular chair and height being sat upon. For more information contact Bodyworks, Triq Wied il-Ghomor, The Gardens, St Julians. Tel: 99689112 • •

Health & Fitness Today • September 2012 - 19


st from the back rest


Tickle your own fan The “coregasm” has been a myth whispered about in the gym for many years, however scientific study has now proved the phenomenon, serving as motivation for women all over the world to get their trainers on and head down to the gym.


Donatello Pisani Donatello is Master Trainer at The BodyForge. He has been involved in health & fitness for more than 20 years. He’s a qualified pharmacist and competitive bodybuilder, having represented Malta in international competitions. He is also a personal trainer and a nutritional advisor

n the past 20 years, I have tried all manner of tricks, ploys and ruses to get women to exercise. For some reason, it is a bit more difficult not only to get women into the gym but also, to keep them there for enough time to start seeing differences take place in their bodies. Sadly, a lot of women leave the gym just before the magic starts to happen. Any gym member will tell you that they have started a fitness program, primarily, to be healthy. However, most of them will say that they are also doing it because they want to look good and the whole purpose of “looking good” usually involves attracting the opposite sex (or the same sex if you are programmed that way). After years of hearing about the urban legend known as the coregasm, The Centre for Sexual Health Promotion at the University of Indiana, has taken this phenomenon seriously enough to conduct a full study on it. The results of the study found that women can actually have an orgasm while working out. Published in the peer-

20 - Health & Fitness Today • September 2012

Results of the experiment 4 Excercise induced orgasm was experienced in the following exercises – abdominal exercises (51.4%), weight lifting (26.5%), yoga (20%), bicycling (15.8%), running (13.2%) and walking/hiking (9.6%). 4 Most women said they were not fantasizing sexually during their experiences so it would seem to be simply physical. 4 Most women reported feeling self-conscious about it because they were in public places. Sex in public will do that to you, though for some that is part of the appeal of having sex in public. 4 It wasn’t just core exercises in this survey. Yoga, running and walking also were among the catalysts. 4 About 40% of women who had experienced pleasure or orgasms during exercise had done so on more than 10 occasions.

reviewed journal Sexual and Relationship Therapy, the researchers, headed by Debby Herbenick, conducted an online survey that included 530 women, in which 246 women experienced exercise-induced sexual pleasure (EISP) and 124 actually reached climax and had an exercise-induced orgasms (EIO). The phenomenon is called the “coregasm” in a coining of words that links the core muscles, which are usually involved in exercise-induced sexual pleasure, with sexual climax – the orgasm. There are, in fact, various

types of physical exercise that were found to be associated with EIO and EISP, including abdominal exercises (51.4%), weight lifting (26.5%), yoga (20%), bicycling (15.8%), running (13.2%) and walking/ hiking (9.6%). Though little is known scientifically about what triggers an EIO, it seems to be a combination of two factors – external clitoral stimulation, which happens when the legs are rubbed together and the stimulation of the deeper pelvic muscles via core exercises. The external clitoral stimulation gets the initial feelings associated with sexual arousal going while the

The coregasm workout EIO is achieved through external clitoral stimulation, which happens when the legs are rubbed together and the stimulation of the deeper pelvic muscles via core exercises

pelvic muscles, when contracted during the exercise in a fashion similar to what happens during actual orgasm, will add on to the feeling of arousal to reflexively trigger off an authentic orgasm. Thus ladies, keep the following in mind when attempting the orgasmic workout: first, keep your legs pressed tightly together to encourage clitoral stimulation, and second, focus on those deeper, pelvical muscles which will help in triggering everything off. This focus can be done by pulling the abs in and down and trying to create a partial vacuum during the exercises. It takes a little bit of practice, but the results will be orgasmic.

While possibly the best way to help achieve EIO, will not necessarily work on all women, even if these are normal in every respect and are able to achieve orgasm in what is the broad spectrum of otherwise normal ways. The following exercises are used because they anecdotally seem to be the ones most commonly quoted to work more than others. Something different could work for you (in which case, feel free to write in and tell us about it).

1. Negative only chin ups Use the rests on the pull-up machine (or a stool or a bench if your machine doesn’t have rests or if you are using a free pull up bar) to start at the top of the movement. Then lower yourself down slowly, keeping legs tightly together. At the bottom of the movement, get back on the rests and raise yourself up to the top position and repeat. Keep in mind that an assisted pull-up machine will remove the core from this movement and thus will not work.

2. Hanging leg raise Tightly grip a chin up bar and hang downwards in a vertical position. Keep your legs straight and raise your feet in front of you, till you are bent at 90 degrees from the middle. Lower slowly and repeat.

3. Garhammer raise Lie flat on your back. Raise your legs in the air while keeping them straight, until they are angled at 90 degrees to your upper body. This is your starting position. Now, use your abs to pull your butt and your hips off the ground and push your feet higher upwards. Return your hips to the ground and repeat.

4. Arm supported reverse crunch Sit down on a gym mat placed on the floor with your legs straight in front of you. Put both arms slightly behind you with your hands flat on the ground so they can support your body. Lean your torso slightly backward. This is the starting position. Now, raise your legs off the ground while keeping them tightly together and at the same time, bring your torso forward, to crunch the abs. Relax and return to the starting position. Repeat.

Sequence Perform 10-20 reps of each exercise, moving from exercise 1 to 4 with about 10 seconds rest between each exercise. Try to go for a total of 5 circuits. Or until you know you have achieved your goal. For more information contact Donatello Pisani at The BodyForge, Santa Marta Street, Victoria Gozo. Tel: 2156 6626, 9940 7151 • •

Health & Fitness Today • September 2012 - 21


ancy at the gym


Build strength and endur


n Russia, kettlebells have long been revered as the fitness-tool of choice for Olympic athletes, elite special forces and martial artists. The kettlebell’s ballistic movement challenges the body to achieve an unparalleled level of physical conditioning and overall strength. Kettlebell workouts typically are designed to maximize the affected muscle groups compared to standard strength training exercises that focus on one muscle group at a time. This allows for you to get a complete workout in less time than if you worked out with traditional strength training equipment. Additionally, unlike normal strength training equipment, when lifting a kettlebell, the weight’s centre of balance is extended past the hand. This allows for a swinging motion and a constant change in the weight’s centre of balance that is unavailable with standard dumbbells or barbells. By swinging a kettlebell, the user will have to engage his core to maintain control,

Richard Geres Richard is an internationally certified personal trainer and weight-loss consultant. He specialises in fat-loss and physique enhancement

which helps produce an excellent whole body workout. Finally, unlike normal weight lifting, kettlebells provide both a cardio and strength training program simultaneously. Having to engage multiple muscles and the constant moving nature of the kettlebell will cause the user to have a higher heart rate than normal seated weight lifting.

Movement progression

The great thing about kettlebell training is that it is built on a succession of pro-

gressions. Starting from the deadlift, the movements progress to the swing, the clean and ultimately to the snatch. The foundational technique always remains the same. Basically kettlebell training is about two movements: pushing and pulling. Pushing movements include the kettlebell press and its variations and the horizontal press as in the Turkish Get-Up, and pulling movements such as the swings and its variations.

The foundational lifts

The Russian Kettlebell Challenge covers the following foundational lifts:

1. The sumo deadlift

The deadlift teaches you how to lift an object off the floor, therefore making it probably the most functional of all movements. After all everybody picks stuff up from the floor once in a while. Problem is, most people do it wrong. Here’s the right way: Bend your knees slightly, then bend over from the hips keeping you back straight

or slightly arched. This is not as simple as it sounds! Many people find it extremely difficult to bend over from the hips while maintaining neutral spine position. Lack of neutral spine during a lift is a recipe for spine or disc damage in the short or long run. The weight (object) must be positioned between your feet, ideally over the centre of your feet, but never in front. Lift the weight by bringing your hips forward , straightening your knees and hips. Once in an upright position assume a rigid position by contracting your quads, glutes and abdominals. This makes your body strong and protects your back. All swings progress from the deadlift, so it is imperative that you get this movement right before attempting any swings.

The Swing

The swing is a ballistic movement, just like a bullet. An initial acceleration drives the kettlebell through the legs until it “floats” in mid-air in the forward position. The acceleration comes from the hamstring and gluteus muscles which contract in a powerful way in the beginning of the movement. The forward movement of the hips “throws” the arms forward until the arms are in a horizontal position. Variations of the swing include the towelswing, the power swing, the overspeed swing and the one-arm swing.

The clean

The Clean serves to rack the kettlebell in preparation for a press or for a front squat. With the upper arm tight against the rib cage, elbow bent and the wrist neutral, the kettlebell is held tight against the chest.

The Snatch

1-Arm back swing

22 - Health & Fitness Today • September 2012

2-Arm swing

This is undoubtedly the toughest of all swing variations. In the snatch the kettlebell finishes with the arm in a vertical, locked-out position, wrist in neutral and the ball of the kettlebell resting against the forearm. The art is to minimise impact of the

kettlebell on the forearm in the top position by spearing the hand forward before lockout and making the kettlebell rest on the forearm with minimum impact. On the way down the kettlebell rotates in the fingers to minimise grinding effect on the palms and fingers. I found out how NOT to do this the hard way – the skin on my palms is still growing back.

The idea is to get up from a lying position on the floor into an up-right standing position and back with a kettlebell in a pressed out overhead position at all times. The move is very technical, and to learn it, must be broken down into its components. It’s a great full body conditioning movement, working practically every muscle in the body.

The press

The squat

From the racked position following a clean, the kettlebell is pressed overhead. To generate maximum power, keep the quads and glutes tight, abs braced and use power breathing to enhance strength.

The Turkish get-up

The Turkish get-up is a challenging, full-body movement.

Kettlebell variations of the squat include the front squat and goblet squat. Emphasis is placed on full range of movement (thighs parallel to floor or below), neutral spine and abdominal bracing for a strong and safe back. For more information contact Richard on


Kettlebell workout: Alternate 45 seconds of work with 15 seconds of rest/transition 1. Half-kneel to stand – left (start with the kettlebell overhead, put it up with both hands) 2. Half-kneel to stand – right 3. Two-arm swing 4. Goblet squat 5. Kneeling windmill left 6. Kneeling windmill right 7. Two-arm swing 8. Goblet squat 9. Partial get-up: Lying to sit-up left 10. Partial get-up: Lying to sit-up right 11. Two-arm swing 12. Full Turkish Get-Up left 13. Full Turkish Get-Up right 14. Two-arm swing 15. Goblet squat Goblet squat

Turkish get up - sit up

Turkish get up - kneeling

Health & Fitness Today • September 2012 - 23


urance with Kettlebells



Lost 15kg of fat



‘It’s nearly 8 months since I finished this program. , My fat weight is still the same. This to me proves that this is not a one-off diet but a life style change which can be adopted on a daily basis . I lost over 16 kilos of fat over 16 weeks, and have kept them all off. I never imagined I would feel this way at 48.

Stellina Galea

YOU ARE UNIQUE AND SO ARE YOUR NEEDS Get enrolled in a program that is designed to meet those needs SPECIFICALLY. Custom made programs for you and your body to give you the results YOU WANT EVERY TIME! With Bodies ‘N Motion, you get what you pay for... LASTING RESULTS! - JOHN XUEREB Contact John Xuereb of Bodies ’N Motion for a FREE consultation to see about bringing the complete mind and body transformation you have always been dreaming of.



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Tel: 79917011, 21422422 or email You can also ask to join the Facebook group page conceive, believe and achieve.

Bodies ’n Motion

Mindset training for life changes There is increasing evidence that the difference between top achievers and the average Joe is not really a focus on improved skills but on the way in which they improve their mind set in order to reach their goals.


he most important workout in a complete mind and body lifestyle transformation is the one that happens inside your head – your brain. The brain is an organ that controls the functions of the body, sometimes referred to as a muscle of thinking. Even though it is not actually a muscle the brain it is the most important organ because it controls all of the bodily functions as well as the other organs. The brain not only controls the skeletal and muscular systems but also the central nervous system and the Autonomic Nervous System, controlling functions below the level of consciousness like heart rate, digestion and respiratory rate among others also controlling moods, drives, and instincts. As with any other organ the human brain will vary in weight from person to person but it is around 1.5kg (80% of which is water). On average, a woman’s brain is 200g lighter than a man’s, due to the fact that men, on average, have bigger heads. Weighing in at just 2% of human body weigh, the relatively small organ has to be the number one priority in changing lifestyle both physically and mentally. Most people I meet think that

Things that make you go hmmm

john xuereb John is a Canadian born life coach who combines his knowledge of fitness and training with motivational talking to help people change their attitude towards health, fitness and nutrition to acquire real changes in both body shape and mindset.

by training in the gym regularly, or eating nutritious foods, or going for a walk everyday is going to make the big difference in their lives. They place a huge importance on physical efforts but somehow neglect the mind and its very important function. Without incorporating the mind into your daily decisions of change, the chances of real long term success is fleeting. It is true to accomplish anything in life we need to know two things – where you are and where you

4 The average brain weighs approximately 1.5kg 4 The brain represents just 2% of total body weight (in humans) 4 The brain contains approximately 100 billion nerve cells 4 The brain is the most fatty organ in the body containing 10 to 12% lipids whereas normal muscle tissue contains only 5% 4 Development of the brain continues past childhood into adulthood and old age 4 A newborn’s brain triples in size in the first year after birth 4 Unconsciousness will occur after eight to 10 seconds after loss of blood supply to the brain 4 The brain starts to die after three to four minutes after loss of blood supply 4 The brain generates 10 to 20 watts of power when a person is awake – enough to power a light bulb want to go. But knowing where you are and where you want to go simply gives you direction. Action and commitment to change comes from the decision deep inside your head. You have to make a decision, not just for today, not just for a short-term goal, but for something bigger and more meaningful. Sitting down and training your mind to sacrifice, commit, engage and follow through with initial decisions is where the real work begins. We must first decide in our small 1.5kg brain that our life is truly worth the effort that is involved and then we must make the commitment to honour that decision by placing it above all other decisions and making it priority number one. When this takes place and we come to remind ourselves of this everyday, it is then that we can truly change and we can follow our specific path to success.

When you wake up in the morning and look at yourself in the mirror. If you decide you need to make a change, don’t make your first decision signing up to the gym or going to an aerobic class but rather decide to meet back in front of the mirror everyday and start your day with training your brain to accept that you can and will make this change and nothing in the day can deter or derail you from doing what it takes to make your change a complete mind and body transformation.

For more information about John Xuereb’s Life Transformation Programs, you can contact Bodies ’N Motion on 21422422, 79917011 or email contact@bodiesnmotion. com. You can also join the facebook group Conceive, Believe and Achieve

Health & Fitness Today • September 2012 - 25

In the comfort of your home! No diet shakes, no pills, no expensive equipment… We will show you how to transform your body in a healthy, natural way, and how to keep the weight off for good! With over 3200 successful clients in Malta to date, our list of impressive transformations just keeps growing! Here are just a few examples of what you can achieve on our programme in just 10 weeks:

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H 1. 2. 3.

If you must avoid gluten because of Celiac disease or if you’re interested in adding different whole grains to your diet, experiment with these gluten-free options.


n their nutritional profiles, these ancient grains surpass the staples of wheat, corn, oats and rice in our diet. Amaranth comes from Central and South America and while technically a seed, it is used like a grain. Light tan in colour, this tiny seed has a nutty flavour and unique texture. High in protein, with 25% more fibre than whole wheat, amaranth contains high amounts of iron, magnesium, zinc and folate. Cooked amaranth can be used as a hot cereal or added to pilafs and soups. The flour can also be added to baked goods for Millet contains a nutrition boost. more protein than The seeds can be wheat, corn and popped like popcorn rice. Yellow in color, in a dry skillet and the small grains are coated with honey also a good source for a sweet treat. of fibre, iron and Buckwheat is a relB vitamins. Widely ative of rhubarb and used in Africa, not related to wheat China and India, at all. Actually a fruit millet is a versatile seed, buckwheat grain with a mild is a good source of flavour. Richard Geres protein, containing When cooked, the Richard is an all eight essential grain can be used internationally certified Personal Trainer and amino acids, as well as a pilaf or rice Weight-Loss Consultant. as magnesium, fibre, substitute. IncreasHe specialises in fat-loss and physique enhancement calcium and iron. ing the water and Buckwheat also concooking the grain tains the entire range longer creates a of B-complex vitamins. When creamy breakfast porridge. Miltoasted, this triangular-shaped let flour lends a light flavour to grain is called kasha. baked goods. The cooked grains (often Quinoa, like amaranth, is called groats) make a hearty native to South America and breakfast cereal. In Slavic technically a seed. It is related countries, buckwheat is used to the beet, chard and spinach in soups and savoury dishes. plants. Considered a “super The flour can be used to grain,” quinoa contains all make buckwheat pancakes eight essential amino acids or crepes. Look for Japanese and has a protein profile similar soba noodles, which are made to milk. Quinoa also has more from 100% buckwheat flour. calcium, iron and magnesium

4 To make sprouts: Place 2 to 3 tablespoons lentils or sunflower seeds in a wide-mouthed jar and cover with water. Soak overnight. Place a piece of cheesecloth over the top of the jar, and secure with a rubber band. Drain the lentils and shake them so that they are not in a big pile, but some are adhering to the sides of the jar. Place the jar in a dark place, like underneath the kitchen sink. Water and drain twice a day for two to three days until the lentils have sprouts about ½ to ¾ inch long. Leave in a sunny place for an hour or two, then refrigerate.

4 Cooked quinoa will keep for four days in the refrigerator. The dressing can be made several hours ahead of serving.

than whole wheat. The small round grain is available in white, red and black varieties. Quinoa cooks faster and has a lighter texture than most grains. Use in soups, warm or cold salads, or as a gluten-free substitute for bulgur, wheat and couscous.

Quinoa, Lentil Sprout and Rucola Salad

Serves 4 – 6 Use lentil or sunflower sprouts, which have a peppery flavour, in this well-textured salad. These sprouts are very easy to make yourself (see below). You can use black or red quinoa in this dish because they have great texture, but regular quinoa works as well. Ingredients (Serves 4): • 1 cup cooked quinoa, preferably the red or black variety • 1 cup sprouted lentils or sunflower seeds • 4 cups tightly packed rucola salad • ¼ red bell pepper, thinly sliced • 20g broken walnuts • 4 tomatoes, diced • 30g crumbled feta • 2 to 3 tbsp chopped fresh herbs, like dill, tarragon, chives and parsley For the dressing: • 1 tbsp fresh lemon juice • 1 tbsp sherry vinegar or red wine vinegar

• Salt and freshly ground pepper • ½ tsp Dijon mustard • 1 small garlic clove, puréed with a pinch of salt • 6 tbsp extra virgin olive oil 1. Combine all of the salad ingredients in a large bowl. 2. Whisk together the lemon juice, vinegar, salt and pepper, mustard and garlic. Whisk in the oil. 3. Toss with the salad, and serve.

Nutritional information per serving: • 337 calories • 4g saturated fat • 5g polyunsaturated fat • 16g monounsaturated fat • 6mg cholesterol • 21g carbohydrates • 3g dietary fibre • 102mg sodium (does not include salt to taste) • 6g protein

For more information contact Richard on

Health & Fitness Today • September 2012 - 27


Healthy wheat alternatives


Tailor your weight lo your body type If you’ve ever been frustrated by the body shape life handed you and think there’s nothing you can do about it, you’re wrong. Breakthrough science, based on targeting specific types of body fat, can help you lose inches in the most stubborn areas, namely your butt or your gut. Here are the revolutionary diet and exercise tips designed to help you reshape your body for life. While you’re working on losing those pounds, learn the style secrets that will help you fake it until you make it. Body type: Big bottom If you fall into this category, the first secret to slimming down is to understand what type of body fat you’re fighting. Those with big bottoms are carrying around extra subcutaneous fat. This fat that appears just below your skin is actually healthier than belly fat. Unfortunately, it is also harder to get rid of. Subcutaneous fat is associated with healthy cholesterol levels and fewer heart attacks, but it also has less blood flow and holds onto calories, which makes it tough to burn off.

Diet plan: Eat a low-fat diet

Research shows that a low-fat diet actually helps break down stubborn fat cells in your bottom region.

Calcium rich foods Everyone knows dairy products are rich in calcium, however they are also high in animal fats. Here is a list of foods that crank up the calcium levels without the added saturated fat.

Daniel Petre Daniel is a nutritionist registered with the Council for the Professions Complimentary to Medicine. He runs his own clinic, Karma Clinic and has collaborated with the Fortina Spa Resort for the last 10 years. Daniel was the first to introduce body stat and metabolic testing to Malta, as well as food intolerance testing. He is also qualified in Life Coaching

Step 1: Cut back on saturated fats

To get on track with a lowfat diet, begin by cutting down on saturated fats, including animal sources such as high-fat dairy and red meats. Eliminate hidden saturated fats such as hydrogenated oils found in processed foods.

Step 2: Include low-fat dairy in every meal

You don’t have to cut out dairy entirely. Studies demonstrate that calcium helps to regulate the way fat cells store, build up and break down fat. Subsequently, low-fat dairy sources such as milk, yoghurt and cottage cheese help promote weight loss. Choose low-fat (2%), not no-fat dairy.

Meal sampler:

• Butt-blasting breakfast: Lowfat Greek yogurt with fresh fruit and granola • Lunch: Low-fat cottage

28 - Health & Fitness Today • September 2012

4 Dried herbs – Although almost never eaten in large quantities adding an extra pinch or two of dried herbs to sauces will increase calcium intake. Celery seeds, dried thyme, dried marjoram and dried rosemary. 4 Sesame seeds – these provide the most calcium when roasted with 99% DV in a 100g serving. Sesame butter, or tahini paste provides about half the amount of calcium with 43% DV in 100g. 4 Tofu – Fried tofu provides 37% DV per 100g. Tofu prepared with calcium sulphate will naturally provide much higher levels of calcium. 4 Almonds – Almonds are a great source of calcium, whether dry roasted or made into butter, with 27% DV per 100g serving. 4 Brazil nuts – Similarly Brazil nuts are also rich in calcium with 16% DV in a 100g serving. 4 Green leafy vegetables – Dark green leafy vegetables are a great source of calcium, whether raw or cooked. Dandelion greens provide 19% DV in a 100g serving, kale, 9% and mustard greens, 6%.

cheese with tomatoes, cucumbers and grilled chicken • Snack: Low-fat milk with dark chocolate cocoa • Dinner: Lean turkey burger with steamed vegetables

Workout: Curtsy squats & rows

To work off a big-bottom area, do resistance training and get a cardio workout at the same time by using something called “complexes.” Complexes are a type of circuit training consisting

of body sculpting moves, done back to back in a circuit format. Pears should combine curtsy squats and rows. You can do this routine with a resistance band or by holding milk cartons or cans. Start by doing a curtsy. Then, lean forward with your hips and go right into a rowing motion with your arms. Do as many as you can with good form in 30 seconds. Repeat this exercise 2-3 times. You’ll increase lean body tissue, boost your metabolism, and reduce the appearance of cellulite.

Body type: Big belly If you’re struggling to get rid of a big middle, you’re battling visceral fat, the fat located in your abdominal region that surrounds vital organs. While this fat is easier to get rid of than subcutaneous fat, it is also worse for you. Excess visceral fat has been linked to type 2 diabetes, heart disease and cancer. People with big middles tend to have higher levels of cortisol, the body’s key stress hormone. Too much cortisol slows your metabolism and also breaks down muscle, making you hard-wired to store fat.

Diet plan: Avoid spikes in blood sugar Step 1: Avoid refined carbohydrates

First, avoid refined carbs like white bread, pasta and rice that are low in fat and spike blood sugar, which can increase stress and make you hungrier.

Step 2: Eat antiinflammatory foods

Replace simple carbs with

Antiinflammatory foods Some anti-inflammatory foods that not only reduce inflammation and promote healing but also aid weight loss 4 Kelp 4 Turmeric 4 Wild seafood, particularly salmon 4 Shittake mushrooms 4 Green tea 4 Papaya 4 Blueberry 4 Extra virgin olive oil 4 Broccoli 4 Sweet potato 4 Avocado

anti-inflammatory foods such as barley, buckwheat and amaranth. These whole grains stabilize blood sugar and help control cortisol surges. Go for

other healthy anti-inflammatory fats, too, like olive oil, avocado, sea bass and salmon.

Workout: Metabolic disturbance training

To shave off your big middle, you want to practice interval training that involves sudden bursts of highintensity movement alternated with lower intensity movement. Using an exercise

stepper, begin by stepping up and down at a moderate pace for two to five minutes. Then crank up the pace for 30 seconds to one minute, until you can feel your heart rate has increased and you’re slightly out of breath. Then go back to the more moderate pace. Repeat throughout the workout. This method boosts both your aerobic and anaerobic systems to speed metabolism and burn belly fat.

For more information contact Daniel at Karma Clinic, Church Hill Court,Vjal Ir-Rihan. San Gwann. Tel: 9944 0384 • •

Health & Fitness Today • September 2012 - 29


loss programme to

Looking for a healthy drink that tastes great? Trying to decide on a juice vs a smoothie. Find out why a smoothie is definitely the way to go. What exactly is a smoothie? •

Smoothies are a blend of whole crushed fruit and pure fruit juice (not made from concentrate). Smoothies count as at least 2 of your 5 A DAY. This is only the case where they contain both pure 100% fruit juice and all of the edible, pulped fruit and/or vegetable. One portion is defined as at least 150ml of fruit juice or 80g of fruit or vegetable. Some bottled smoothies available in Malta may actually contain more pulp, which means more fruit. However there are also smoothies, which may contain yoghurt or reconstituted fruit juice, these do not qualify as two portions of fruit.

Smoothies are made from 2 portions of fruit •

A fresh fruit smoothie is the equivalent to a minimum of 2 portions of fruit. A 250ml smoothie should contain

at least 1 portion of whole crushed fruit (80g) and 1 portion of juice (150ml) or contains more than 80g of whole crushed fruit with the remainder of the second portion made up from fruit juice.

Smoothies are nutritionally equivalent to fruit Smoothies have the same amount of energy and sugar as 2 portions of fruit. 

Due to the whole fruit content of Smoochie smoothies they are nutritionally equivalent to fruit. The graph below shows that a 250ml smoothie is the same as 2 portions of fruit for energy and sugar. Smoothies also contain vitamin C and anti-oxidants just like whole fruit.

Smoothies Freshly squeezed OJ Energy Protein Carbohydrate Sugars Fat Fibre Vitamin C Source of fibre Source of vit C Antioxidants

kcal/100mg g/100mg g/100mg g/100mg g/100mg g/100mg mg/100mg >1.5g per 100kg >15% RDA ORAC (TE) umol/100ml

partment of Health guidelines due to the negligible fibre content and lack of variety of fruit. Smoochie

58 0.5 13 12 0.2 1.4 23.1 Yes Yes 1566

43 0.7 9 9 0 0.1 30 No Yes 900

smoothies are fundamentally nutritionally different to juice however as they are a source of fibre, are made with a variety of different fruits and have more anti-oxidants than orange juice.

Smoothies also have the same amount of fibre as 2 portions of fruit

Smoothies have superior nutrition to juices • Juices are classed as one portion of fruit under the DeEnergy, sugar and vitamin C of 2 portions of fruit versus smoothie.

Fibre of 2 portions of fruit versus 250ml smoothie.

Average of 11 smoothie recipes compared to banana (l120g)* and 80g of strawberries, cherries and mango. (Source : *Food Portion Sizes by Helen Crawley (HMSO, Source: McCance and Widdowson “The Composition of Foods”).

Health & Fitness Today • September 2012 - 31


Smoothie or juice?


Tropical heaven smoothie This is a tasty, refreshingly delightful blend of mango and pineapple that is an oasis of freshness in what remains of the summer heat. The mango adds a number of health benefits including lowering of cholesterol, clearing the skin, promoting eye health and alkalising the body, while the pineapple improves digestion and prevents coughs and colds. The flaxseed oil promotes slimming and the strawberries are just yummy. Time: 5 minutes Serving: 2 Ingredients • 1½ cups frozen mango cubes or peach slices, slightly thawed, or 1 large mango, peeled and sliced off pit • 1 cup fresh strawberries, hulled and halved • 1 cup fat-free vanilla yoghurt or light vanilla soy milk • ½ cup chilled mango nectar • 1 tbsp frozen pineapple juice concentrate, slightly thawed • 2 tbsp flaxseed oil

Nutrition Info Per Serving tein, ries, 8g pro lo ca 9 39 s, drate 14g 65g carbohy rated fat, tu fat, 1.5g sa erol, 86mg 2mg cholest fibre 5g , sodium

Method • 1. Place mango, strawberries, yoghurt, nectar, and juice concentrate in blender. • 2. If using fresh mango, add 4 or 5 ice cubes. Blend until well combined and smooth. • 3. Add oil and blend just to combine. • 4. Pour into 2 glasses. • 5. Garnish each glass with a strawberry if you have extras.

Flaxseed oil Flaxseed oil (also known as linseed oil) is rich in Omega-3 fatty acids and a multitude of vitamins and is recommended for general well being.

4 Research shows low incidence of breast cancer and

colon cancer in populations that have high amounts of lignan in their diet. Flax is 100 times richer in lignan than most whole grains.

4 Increases the body’s production of energy and also increases stamina.

4 Accelerates the healing of sprains and bruises. 4 Eases weight loss in people afflicted with obesity. 4 Stimulates brown fat cells and increases the metabolic rate making it easier to burn off fat

4 Studies show that Omega-3 fatty acids help lower cholesterol and blood triglycerides, and prevent clots in arteries, which may result in strokes, heart attacks and thromboses.

4 Helps protect the body against high blood pressure, inflammation, water retention, sticky platelets and lowered immune function.

4 Shortens recovery time for fatigued muscles after exertion.

32 - Health & Fitness Today • September 2012

At no more than the size of a fist, the human heart is the strongest muscle of the body, beating on average 100,000 times a day, which will add up to a total of about 2.5 billion heart beats in a 70 year lifespan. However not every person’s heart makes it to that many heart beats with heart disease accounting for approximately 17 million deaths each year


nyone can develop heart disease. It occurs when a substance called plaque builds up in your arteries. When this happens, your arteries narrow over time, reducing blood flow to the heart. The World Health Organisation (WHO) estimates that more than 17.3 million people died of cardiovascular diseases such as heart attack or stroke in 2008. In Malta, in 2008, 678 deaths occurred from ischemic heart disease amounting to 21% of all deaths in the country for that year. By 2030, WHO has predicted an increase of death from cardiovascular disease to 23.6 million. Extensive clinical and statistical studies have identified several factors that increase the risk of coronary heart disease and heart attack. Unfortunately there are a number of major risk factors that can’t be changed.

Dr Charmaine Gauci Charmaine is the Director of the Health Promotion and Disease Prevention Directorate. She is a senior lecturer with the University of Malta and delivers lectures in the field of public health with special interest in Epidemiology and Communicable Diseases. She is active in the field of public health and is currently also the President of the Malta Association of Public Health Medicine.

Increasing age

Over 83 percent of people who die of ischaemic heart disease are 65 or older.

Male gender

Men have a greater risk of heart attack than women do, and they have attacks earlier in life. Even after menopause, when women’s death rate from heart disease increases, it’s not as great as men’s.


Children of parents with heart disease are more likely to develop it themselves. Therefore, it’s even more important to treat and control any other risk factors you have. Looking at the positive

side, there are major risk factors which can be controlled and there is enough evidence to show that they can reduce the risk of heart disease.


Cholesterol is a waxy substance produced by the liver or consumed in certain foods. It is needed by the body, and the

Health & Fitness Today • September 2012 - 33


Keeping to the beat


Blood pressure

High blood pressure is another major risk factor for heart disease. There are often no symptoms to signal high blood pressure in fact it is often called the silent killer. Lowering blood pressure by changes in lifestyle and by medication when required can lower the risk of heart disease and heart attack.


Diabetes also increases a person’s risk for heart disease. For people with diabetes, it is important to seek advice on managing it and controlling other risk factors.

Tobacco use

liver makes

34 - Health & Fitness Today • September 2012

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.

Tobacco use increases the risk of heart disease and heart attack. Tobacco 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.


Dietary factors affect heart health. Diets high in saturated fats and cholesterol raise blood cholesterol levels and promote atherosclerosis. High salt or sodium in the diet causes raised blood pressure levels.

By 2030, WHO has predicted an increase of death from cardiovascular disease to 23.6 million

plenty of fruit and vegetables, whole grains, lean meat, fish and pulses, and restricted salt, sugar and fat intake.

Maintain a healthy weight.

Know what your healthy weight is and work towards that weight.

Don’t smoke.

If you don’t smoke, don’t start. If you do smoke, quitting will lower your risk for heart disease. The risk of heart attack and stroke starts to drop immediately after a

person stops using tobacco products, and can drop by as much as half after one year. Speak to your doctor if you have high cholesterol, high blood pressure, or diabetes.

Exercise regularly.

Physical inactivity

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.


Obesity is a direct risk factor for heart disease and is often linked to higher LDL (bad) cholesterol and triglyceride levels and to lower HDL (good) cholesterol, high blood pressure, and diabetes. So now we know the risk factors for developing heart disease. Just knowing is not enough so we need to act and act fast. The first step toward heart health is becoming aware of your own personal risk for heart disease. Some risks, such as smoking cigarettes, are obvious but other risk factors, such as high blood pressure or high blood cholesterol, generally don’t have obvious signs or symptoms. So a regular visit to your doctor will help identify these factors and manage them before they do further harm.

Eat a healthy diet.

Choose a balanced diet with

Physical activity can help you maintain a healthy weight and lower cholesterol and blood pressure. At least 30 minutes of regular physical activity every day helps to maintain cardiovascular fitness; at least 60 minutes on most days helps to maintain healthy weight. Start being active now. Get up off of your sofa or PC and get moving. Every step counts.

Early warning signs High blood pressure, diabetes and stress are all indicators of cardiovascular disease. However by the time it has reached this staged the situation is already dangerous. Early warning signals often go undetected though may be a red flag of trouble to come. Sexual dysfunction 4 Trouble in the bedroom may be a sign of an ailing cardiovascular system. Sexual function involves the flow of blood to the genetalia therefore a circulatory problem will reduce, if not completely inhibit sexual performance. Loss of hair 4 Lack of circulation to the hair follicles resulting in hair loss may the result of cardiovascular disease according to a report published by the Archives of Internal Medicine, which found a correlation between top rear balding and cardiovascular disease in males.

Snoring and sleep apnea 4 A study by the Emory University in Atlanta found that obstructed airways in people who have sleep apnea or who snore were linked to heart disease. Disturbed sleep may be a predisposition of high blood pressure and diabetes, both contributing to heart disease. Migraines 4 Women experiencing migraines with visual or sensory disturbance at least once a month were found to be twice as likely to develop heart disease according to a study by the American Academy of Neurology. Circulatory irregularities that cause severe headaches have been linked to cardiovascular problems. Each of the symptoms above may be caused by more than one factor and loss of hair does not directly indicated cardiovascular failure. However if you are at high risk of heart disease and are experiencing any these symptoms discuss them with your doctor.

For more information contact the directorate on or 23266000.

Health & Fitness Today • September 2012 - 35


Men have a greater risk of heart attack than women, and have attacks earlier in life


Going under the kn

Now that the summer is ending and autumn approaching some of us may be considering a plastic surgery procedure in preparation for Christmas and the New Year. Plastic surgery operations are a very serious undertaking and cannot be approached as if one is shopping for a nice dress or changing a hairstyle! A lot of preparations and thought are required before committing to an operation.


he following points may help you keep safe in the process:

Get the timing right: Generally avoid surgery if you have recently experienced major life events such as moving house, changing job, losing a loved one, the break-up of a relationship or the arrival of children. Talk to your family doctor: Many doctors are happy to advise you and not be judgemental about something which you may feel very sensitive about. Be informed: Anyone considering any cosmetic procedure should ensure they are fully informed and accept the limitations and risks of any procedure. Remember, no surgeon or procedure is 100% risk free. Know your surgeon: A plastic surgeon has to have been fully trained and assessed by peers during the training and certified by a reputable body, like the Certificate of Completion of Surgical Training in the UK or American Boards Certification. Learn to assess

Raymond Debono Raymond is a consultant plastic and reconstructive surgeon in practice in Malta and the UK. He studied in the UK and the US and specialises in facial rejuvenation, cosmetic breast surgery and body contouring, skin cancer treatment, breast reconstruction, hand surgery and laser treatment

Cosmetic surgery statistics 4 More than 1.6 million surgical cosmetic procedures were performed in the US in 2011 4 18% of total surgical procedures performed in the US in 2011 were cosmetic in nature 4 Cosmetic surgical procedures increased by 1% over last year 4 Cosmetic surgical procedures increased by 73% since 1997 4 Lipoplasty has overtaken breast augmentation to become the most widely sought after cosmetic surgery, increasing by 13% over last year 4 The top 5 cosmetic procedures performed in 2011 were liposuction, breast augmentation, abdominoplasty (tummy tucks), blepharoplasty (surgical modification of the eyelid) and breast lifts Source: American Society for Aesthetic Plastic Surgery

36 - Health & Fitness Today • September 2012

the qualifications of a Plastic Surgeon and if in doubt ask; the Medical Council is a good source of information. The best way to select your plastic surgeon is to do your own detailed research. Do not rely on a single person’s recommendation. Take your time and look for as many details and facts as you can. Know your options: For a cosmetic problem there are often a few options for treatment. You need to know all these options and the pros and cons of each option. Your surgeon is duty bound to put these options to you and help you decide. Make your own decisions: The real expert on your appearance and any concerns you may have is YOU. The only assistance you should need is to decide what, if any, surgery you might need, and you should ensure you get unbiased information regarding what might be technically possible and any associated risks and benefits. Do not let anyone talk you into doing anything for which you had little concern before the consultation. Be comfortable: Make sure you feel comfortable with the surgeon and clinic you have chosen. You can always change your mind: Hopefully everything will be totally to your satisfaction, but remember you must have the option to cancel right up until the time you go to sleep


knife… safely No surgeon or procedure is 100% risk free

for surgery. The fundamental reason for the surgery is to make you feel better about yourself, and if this is compromised, surgery should not proceed. Avoid booking fees or nonrefundable deposits: If the surgery is right for you then there will be no need for you to be locked into going ahead by any financial cancellation penalties. Remember that deposits may be hidden in for example as implant fees. You should be left free to decide. Take your time: You should not rush. Remember that undergoing surgery is a serious commitment.

Lifestyle concerns when considering plastic surgery

Not every candidate should undergo cosmetic surgery as it poses a number of risks that could result in deformity and even death. Most deaths occur from complications with anesthesia and can be avoided by choosing a reliable surgeon and anesthesist. Good surgeons will encourage patients to adopt a healthy lifestyle before and after the scheduled surgery. Some lifestyle factors that may be discussed during a plastic surgery consultation include:

• • • • • • • •

Current weight and history of weight fluctuations Nutrition and vitamin supplements Exercise frequency and type (aerobic or non-aerobic) Smoking habits and exposure to second hand smoke Alcohol consumption Sun exposure Sleep patterns Stress levels and coping mechanisms

For more information contact Raymond at

Health & Fitness Today • September 2012 - 37


Strapping the l Maltese parents have been described as being overbearingly protective of their children at times. Use this charachter trait in a positive manner and strap your little ones in safely.


n 2010, in the UK, over 5,000 children under the age of 12 were killed or injured in car accidents – 15 were killed, 225 were seriously injured and a further 5,000 were slightly injured. A great number of these injuries and even some deaths could have been avoided if proper child restraints were used. There was a registered increase of 3.9% in traffic accidents in Malta last year where 14,264 accidents were reported, and 17 people were killed. I can’t figure out why a parent in their right mind would take the risk of losing a child in a car accident that could have been avoided. Accidents happen regardless of how carefully one drives. Other drivers may be speeding, using the phone while driving, driving under the influence of alcohol or simply not paying attention – the result of which could be fatal for an unrestrained child. The sight of a toddler jumping from the front seat to the back and back again is not an uncommon sight on Maltese roads, nor is a bunch of young faces staring at you through the back windscreen as the kids are more than likely unrestrained and on their knees looking out, or even mothers cradling their young babies or holding onto cots rather than having them restrained in proper seats. Many times I am tempted to stop the car in the middle of the road and tell them about the dangers they are putting their child into. Mostly I don’t give in to this temptation, but sometimes I do. Recently, while I was stuck at a red light, I rolled down my window and told a mother driving the car next to me that her child was not at all safe jumping in the back seat without a seat belt, let alone

Sylvana Brannon Sylvana is a single mother of four children, and the managing director of Smart Cells Malta which stores placental stem cells. After the birth of her first child, she set up a non-profit organisation, mamaKNOWS, where she acts as childbirth educator and offers parenting support to new mums.

38 - Health & Fitness Today • September 2012

proper car seat. The woman’s response was to tell ME to be angry with her son and to scare him! I often get told about people whose children simply won’t stay in their car seats. If you cannot be a proper guide to a child of five, what is your relationship going to be like when the child is 15 and needs to be able to respect boundaries so much more at this vulnerable age? This kind of behaviour is just setting a pattern for the future. Some even say that it should be up to the police to dish out fines to ensure child safety, but why should we wait until we get a fine before we decide to keep our own children safe in our own cars? Some mothers simply feel safe holding a baby in their arms in the back seat, relaxing under the false impression that they are holding their baby so tight that nothing could possibly hurt that child. Research has shown that in an accident at just 40km per hour, that

An unrestrained child would be thrown with a force 30 to 60 times their own bodyweight, injuring or possibly even killing both the child and anyone else who happens to be in the car child would be flung out of a mother’s arms no matter how tightly she was holding onto it. An unrestrained child would be thrown with a force 30 to 60 times their own bodyweight, injuring or possibly even killing both the child and anyone else who happens to be in the car. The child can also be flung out of the windows or even go through

What type of restraint? Making sure that each child has the correct safety restraint for them is extremely important to ensure the restraints are doing more good than harm. • • • •

0-2 years - (up to 13kg) – Rear-facing child seat 2-4 years (9-18kg) – Forward-facing child seat 4-8 years - (144cm) – Booster seat Children over 144cm tall – adult seatbelts

the windscreen. Car seats are known to reduce the risk of death in passenger cars by 71% for infants, 54% for toddlers aged between one and four, while booster seats can reduce injury in accidents involving children between the age of four and seven by 59%.

Types of restraint

It is very important to use

the right kind of restraint when children are travelling in cars, and not to use an adult belt before the child is big enough. Seatbelts and airbags are designed for adults and in the event of an accident can do more harm than good if they are improperly fitted. Children under two should always be placed in rearfacing car seats as the most dangerous accidents are

frontal collisions. When a child is facing forward the child is flung forwards being caught in the harness and putting stress on the neck, spine and internal organs, leaving the neck unprotected as the head is flung forward. The soft bone structure of an infant means that it is less able to withstand such force and the child can be internally decapitated, or the soft ribs will be unable to protect the internal organs. In a rearfacing car seat the force of impact is distributed evenly along the whole back of the seat. Once children outgrow their car seats, they need to make use of booster seats until adult seatbelts properly fit the child. The seatbelt fits when the lap belt lays across the upper thighs and not the stomach and the shoulder belt fits across the chest and not the neck.

Car seats are known to reduce the risk of death in passenger cars by 71% for infants, 54% for toddlers aged between one and four, while booster seats can reduce injury in accidents involving children between the age of four and seven by 59%

Children under the age of 13 should always travel in the back seats as deployment of the airbags could cause head and spinal injuries as the airbag is hitting the child in the face rather than the chest as it is intended.

Health & Fitness Today • September 2012 - 39

kids health

little ones in

[ National Breast Screening Programme 2012 ]

Malli irċevejt l-ittra biex immur ! għall-breast screening ħtaft l-opportunità halli nserraħ rasi u dik tal-familja tiegħi. Servizz professjonali bi privatezza kbira u b’xejn! Lanqas irrid nemmen li hawn min jirrifjuta għax għalija saħħti tiġi l-ewwel!


screening appointment !wasMyanbreast opportunity that I could not afford to lose. I needed to reassure myself and my family that I was well. Even though it’s free, the service is very professional and conducted in full privacy. My health is of utmost importance so I find it hard to understand those who turn down the invitation.


For further details contact us on: Tel: 21227470/1, e-mail: or visit

Three years into the National Breast Screening Programme, the majority of women who have taken part are satisfied with the services and would recommend having a mammogram to relatives and friends.


reast cancer accounts for 23% of female cancers worldwide. In both Malta and the UK the incidence of breast cancer is much higher at 32%, making it the highest rate in Europe. Breast cancer affects one in eight women, though if it is detected early enough, while it is still in the localized stage, survival rates for the next five years are as high as 98%. Since the opening of the National Breast Screening Programme in October 2009, Maltese women born between 1950 and 1959 have been invited to undergo mammography screening every three years. Presently, the programme is in its initial cycle, though it is set to expand in the future. A woman’s experience of her initial screening can influence her decision on whether to participate in subsequent screenings or not. Studies have shown that the physical, psychological and social aspects associated with and resulting from the screening process increase or decrease client satisfaction. Previous studies regarding client satisfaction with mammography screening have focused on diverse but specific aspects of the screening pathway, and although such studies have been undertaken in other European countries, this is the first time that we have investigated customer satisfaction with the Malta Breast Screening Programme. We went about it through a telephone interview survey in 380 women who had already participated in the Programme, including both those with a normal initial screen and those recalled for further tests. The aim was to identify those factors that affect client experience and explore the views of

Danika Attard Danika is a senior radiographer who is part of the National Breast Screening Programme. She is doing a Masters in Medical Imaging (Mammography) at Kingston University in London

women themselves in order to assess satisfaction with information, waiting time, the physical environment, pain and discomfort, and interactions with staff.

The Results

Women’s experiences of their appointment, care perception and overall programme were described in a very positive way, with all respondents claiming that the service was either “good” (31.3%) or “excellent” (68.7%). Women were asked to identify what they liked most at the breast screening unit. Women pinpointed the radiographer’s professionalism who showed “effective communication skills,

care and competence” and all the staff at the Screening Centre who were “friendly and helpful”. Many women stated that they were impressed with the efficiency of the service and said that it was “the best” they had ever experienced. Furthermore, all clients were very satisfied with the centre’s environment since they “felt at home”. “The unit is very clean. The employees are neat. Everything is well kept” (Breast Screening client). 29.7% of participants faced difficulties in accessing the unit due to the “busy road”, “no bus access” and “limited parking”, resulting in less overall programme satisfaction. The general public’s percep-

Health & Fitness Today • September 2012 - 41


Breats screening satisfaction


Factors that cannot be changed 4 Gender – although men can develop breast cancer it is 100 times more common in women 4 Ageing - About 1 out of 8 invasive breast cancers are found in women younger than 45, while about 2 of 3 invasive breast cancers are found in women age 55 or older 4 Genetics – 5% to 10% of all breast cancers are hereditary. Having a mother, sister or daughter with breast cancer doubles the risk of developing breast cancer 4 Personal history of breast cancer – having breast cancer in one breast increases the risk 3 to 4-fold of developing it in the other breast 4 Dense breast tissue – the denser the breast tissue the more likely it is to develop cancer. Unfortunately it also makes it more difficult to detect 4 Menstrual periods – women who started menstruating before the age of 12 or continue after the age of 55 have slightly higher risk due to a longer lifetime exposure to oestrogen and progesterone Lifestyle related factors 4 Having children – women who have not had children or had their first child after 30 are at higher risk 4 Birth control – oral birth control pills or injectable progesterone increases the risk of breast cancer due to high. However risk factors return to normal after a woman has stopped taking birth control after 10 years 4 Hormone therapy after menopause – Increasing exposure to oestrogen has been proven to stabilize mood swings but increase the risk of breast cancer 4 Breastfeeding – breastfeeding for 1½ to 2 years may slightly lower the risk of breast cancer though this has been hard to prove as breastfeeding does not normally continue for that amount of time

42 - Health & Fitness Today • September 2012

tion of the mammography test has sometimes been reported to be one of pain and furthermore, mammography has been reported as painful in worldwide studies. In this local research, those who found mammography “severely uncomfortable” or “severely painful” had a less than excellent score on women’s satisfaction. Nonetheless, many women in this study felt that “the radiographers’ professionalism and effective communication during the test were the leading factors that, in turn, communicated care, confidence and competence to them and their families”. In fact, almost everyone felt at ease and commented that the radiographer provided excellent care. “The ‘contact’ with the Radiographer made all the difference” (Breast Screening client). More than half of participants experienced anxiety prior to mammography (56.3%) and higher anxiety (92.3%) when recalled for further tests. When attending for further breast assessment, the client majority was still very satisfied with the overall communication. However, those

women who underwent a biopsy were less satisfied than nonbiopsied women, mainly due to the increased anxiety about the biopsy. Nonetheless, the majority of women stated that they would re-attend for breast screening. Moreover, all clients would recommend screening to others irrespective whether they were recalled for further tests or not. Being assured of a female radiographer was an impacting factor in this research, leading to a positive screening experience and consequently high satisfaction. In fact, results show that if the radiographer was male, 68.9% of all women would not have undergone the test. This research has contributed to a better understanding of those factors influencing client satisfaction at the Malta Breast Screening Programme. External factors such as location and parking did not influence women’s perception of care within the unit, although a minority faced difficulties with accessing the centre. Social and economic factors proved not to cause inequalities in access to or satisfaction with screening. The internal


• Improving external signage to enhance accessibility to the centre • Providing adequate pre-procedural information to minimize women’s anxiety. • Developing strategies to minimize pain and discomfort • Ongoing service evaluation to ensure that high standards of care are provided and to enable service improvements to meet

women’s needs. • Investigate reasons for nonattendance Research carried out Danika Maria Attard BSc. (Hons.), MSc. (Lond.), MLJ, LRSM, Senior Radiographer, National Breast Screening Programme, as part fulfilment of a Master of Science degree in Medical Imaging (Mammography), Kingston University London. The research work in this publication was partially funded by the Strategic Educational Pathways Scholarship (Malta). This scholarship was part-financed by the European Union – European Social Fund (ESF) under Operational Programme II – Cohesion Policy 2007-2013, “Empowering People for More Jobs and a Better Quality of Life”.

Symptoms of breast cancer Though ageing increases the risk of breast cancer every woman over 20 is at risk and should look out for symptoms. • Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle. • A mass or lump, which may feel as small as a pea. • A change in the size, shape, or contour of the breast. • A blood-stained or clear fluid discharge from the nipple. • A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly, or inflamed). • Redness of the skin on the breast or nipple. • A change in shape or position of the nipple • An area that is distinctly different from any other area on either breast. • A marble-like hardened area under the skin.

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non-clinical, welcoming ambience within the National Breast Screening Centre has created an atmosphere conducive towards increased women’s satisfaction, proving that the modernization of health facilities greatly contributes towards customer satisfaction and care. The results of this nationwide study also concur with earlier studies showing high satisfaction among women in other European breast screening programmes.

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Health & Fitness Today • September 2012 - 45


Relaxing the body and mind Kevin Spiteri Ferriggi Kevin moved to Malta in 1987 from Canada and has been actively involved in the local health & beauty industry since 1997. His areas of expertise include Business Administration, Skincare & Gastronomy


echnically massage was designed to increase functionality of the muscles and aid healing, though today more and more people are including a massage in their regular routine to counteract the stresses of modern day life and relax the mind as well as the body. Until you actually get one, you may feel that a massage is an unnecessary waste of time and money, perhaps even an overrated luxurious treat without any true value or benefit. Have you recently begged your partner for a desperate and life-saving neck or shoulder rub after a particularly strenuous day at work? Only to get a relectant minute or two of forced amateur therapy? And it still felt good right? Perhaps even surprisingly soothing and satisfying. Just imagine how refreshing and re-energising a professionally sequenced treatment that lasts for a full 60 minutes could feel like. Giving a beneficial massage is not an easy task however. Critical knowledge, in depth training and many hours of practice are essential for acheiving a satisfying and more importantly, a safely excecuted massage treatment. It is absolutely recommended to always seek the services of professional masseuse, masseur or physio-

therapist. Always discuss your personal issues and requirements with your therapist so that he or she can work out the most suitable and beneficial program including applied pressure, areas to concentrate on, overall duration and frequency of treatment. Toxins accumulate over time, causing muscles to tense up and create knots which need to be kneaded out repeatedly in a particular sequence of specialisied movements. Loosening tight muscles helps release stiffness, eases pain and increases mobility. Besides the obvious positive physical aspects of massage, there are the related satifisfying results for mental and psychological issues as well. You can certainly achieve a healthier, more pleasant lifestyle through periodic massage which is a complex and powerful code to feeling truly invigorated. Its like re-booting your computer or smart phone when it gets overloaded and

46 - Health & Fitness Today • September 2012

overused. Somehow it regains superior performance. A traditional massage which is sometimes also referred to as a Swedish massage, uses light to moderate pressure according the client’s preference, to achieve a relaxing sensation. This normally works wonders to decrease stress hormones. Studies have shown an increase in the body’s production of white blood cells which indicates a boost in the immune system. A therapeutic massage on the other hand uses firmer pressure and is normally performed on individuals requiring a deep tissue massage to help overcome chronic aches and pains as a result of injuries or other discomforts. Basically it is a more clinical approach and goes beyond the relaxation characteristics normally associated with the traditional massage.

11 healthy reasons for getting a massage

1. Helps deal better with


3. 4.




anxiety and depression. The soothing techniques and movements applied promote relaxation and total well being. Easing of daily aches, pains, arthritis related discomforts and also muscle fatigue. A massage can arguably be as effective as medication in some cases. Attaining better body function, posture, flexibility and enhanced mobility. Promotes healthy sleeping and more restful nights. One might even dose off during the treatment as proof. Immunity boost through an increased production of white blood cells. The power of touch can truly have some remarkable results on the overall function of the body. Alleviates some of the discomforts associated with PMS. This includes mood swings. Feeling recharged raises

Massage therapists are mushrooming all over the island with offering specialist types of massages and different techniques. Considering having a massage but don’t know which one to choose from?

4 Always use a licenced massage therapist

4 Don’t have a heavy meal or consume alcohol before a massage 4 Drink plenty of water after a massage to flush metablolic waste out of the system 4 Consult your doctor before seeking a massage if you suffer from any medical conditions or if you are pregnant

your alertness, brain power and concentration. You will probably handle your next tasks more accurately and with some added enthusiam. 8. Reduces and curbs the intensity of headaches and migraines. Regular suffers may also experience a reduction in the frequency of occurances. 9. Increases blood flow and circulation, helps out the lymphatic drainage system which carries out the body’s unwanted toxins. Nutrients get a clearer and quicker path to the cells. 10. Relieves fatigue and provides comfort to persons suffering from serious illnesses and undergoing intensive medical treatments. Massages are also regularly recommended for palliative care. 11. Adds vitality to the complexion whilst the application of nourishing oils or creams during the treatment helps keep the body’s skin more moist and supple. Please note that persons suffering from any sort of medical condition should consult their doctor before proceeding with a treatment. As a general rule, when in doubt always consult. Massage is a surprisingly pleasant medium to achiev-

Types of massage Massage therapists are mushrooming all over the island with offering specialist types of massages and different techniques. Considering having a massage but don’t know which one to choose from? 4 Swedish massage – Often referred to as a traditional massage, the Swedish massage is the most popular form of massage using long smooth strokes, kneading and circular movements on superficila layers of muscle using massage lotion or oil. Pressure applied varies according to the client’s needs from gentle and relaxing to deep and loosening. The massage improves circulation brining oxygen to body tissues. It relieves muscle pain, increases flexibility and mobility, clears lactic acid and reduces stiffness around muscles and joints. Aromatherapy massage – This form of therapy uses essential oils to address specific needs of the body, whether relaxing, energising, stress reducing or balancing. It is particularly useful for people suffering from stress related conditions or those with an emotional component. 4 Deep tissue massage – This targets the deeper layers of muscle and connective tissue, using slower strokes or friction techiques across the grain of the muscle. It is used for chronically tight or painful muscles, repetitive strain, postural problems or recovery from injury. Chronic muscle pain is usually the result of adhesions – bands of painful, rigid tissue – in the muscles, tendons and ligaments, which block circulation and cause pain and limited movement. Deep tissue massage works at physically breaking down the adhesions to relieve pain and ing a more cheerful mood, optimal performance for your body and mind, plus an aura of positive energy.

restore movement.

4 Hot stone massage – Heated smooth stones are placed on certain points of the body to warm and loosen tight muscles and balance energy centres in the body. The therapist may also use the stones to massage certain areas of the body. The heat from the stones placed along the back, palms of the hand and between the toes, warms and relaxes the muscles allowing the therapist to apply deeper pressure. Cool marble stones are sometimes used to reduce infalmmation. This massage is particularly suitable for people who tend to feel cold, have back pain, poor circulation or oesteoarthritic pain. 4 Thai massage – A mixture of Ayurvedic techniques and traitional Chinese medicine, Thai massage is a more energising and rigorous form of massage technique. The threapist uses hands, knees, legs, and feet to move the client into yoga-like stretches whilst using muscle compression, joint mobilisation and acupressure. The massage relaxes the body, relieving stress and improving circulation. It also increases energy, flexibility and range of motion. 4 Sports massage – Though specifically designed for people whe are involved in physical activity, you don’t have to be an athlete to feel the benefits of a sports massage. The focus isn’t on relaxation bu on preventing and treating injury and enhancing athletic performance. A combination of techniques are used. The strokes are generally faster than Swedish massage and facilitated stretching helps to loosen muscles and increase flexibility.

For more information contact Kevin at MensWorks Mdina Road, Attard. Tel: 7969 1744 • 2144 8800 • •

Health & Fitness Today • September 2012 - 47


Additional tips


Osteoporosis: The silent bone eater Osteoporosis is a condition resulting in weak and fragile bones with a higher susceptibility to fracture and, women are at a greater risk of suffering from osteoporosis than men. This is because women start off with a lower peak bone mineral density than their male counterparts and also lose bone mass at a much faster rate, especially during the years immediately following menopause. Most cases of osteoporosis in females are primary. This means that no contributory disease is present and that the condition is most likely to be due to postmenopausal oestrogen deficiency. Oestrogen is important in the regulation of a woman’s reproductive cycle, but also maintains bone strength such that, when the levels of this hormone fall after menopause, the rate of bone loss increases. On the other hand, causes of secondary osteoporosis include hyperthyroidism, diabetes mellitus, alcoholism, coeliac disease and rheumatoid arthritis, amongst others. Steroid use is also a risk factor for the develop-

ment of osteoporosis. The recommended investigation for diagnosing osteoporosis is the DEXA bone density scan. This compares the patient’s bone mineral density with that of a young healthy adult. A T-score of -1 or greater is normal, while a score between -1 and -2.5 indicates that the patient is at risk of developing osteoporosis. Osteoporosis is diagnosed when the T-score is -2.5 or worse. Postmenopausal women are advised to undergo a bone density scan every 2 years, especially if they have already been diagnosed with osteoporosis. Osteoporosis is a ‘silent condition’, meaning that patients won’t experience any symptoms unless a bone is fractured, however there are still things that can be done to prevent and treat this condition. Some risk factors, such as a positive family history of osteoporosis,

48 - Health & Fitness Today • September 2012

are non-modifiable, but others are. Both women who are osteoporotic, as well as those at risk, can benefit from certain lifestyle changes such as smoking cessation, reduced alcohol consumption, adequate intake of calcium and vitamin D, and weight-bearing exercises. It is also important to educate patients with osteoporosis on how to make their home safer by eliminating any hazards that could increase their risk of falling. In addition to lifestyle changes, pharmacological measures are available for the treatment of osteoporosis. The first line drugs are the bisphosphonates such as Zoledronic acid which is commonly used to treat or prevent osteoporosis in patients taking steroids for a longperiod of time. Zoledronic acid is injected into the vein for 15 minutes once a year. For those who are intolerant to bisphosphonates, strontium ranelate is used. In post-menopausal women, hormone replacement therapy (HRT) can be used to prevent (not treat) osteoporosis. The problem with HRT is that it increases the risk of breast cancer so raloxifene is

preferred which acts similarly to HRT but has a lower breast cancer risk. In the case of males, testosterone shots may help in hypogonadal men. No matter your age, it is never too early to start fighting the battle against osteoporosis. Having a good balanced diet and exercising from a young age can boost your bone mineral density to its peak, thus helping to keep osteoporosis at bay. For more details contact St Anne Clinic on 21 493553/5.

Tel: 2122 3755

Health and Fitness Issue 3  

Health and Fitness Issue 3

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