Strength­en­ing your core

Your core muscles are essen­tial to sup­port your spine, but many people often for­get to exer­cise them.

     https://www.pressreader.com/malaysia/the-star-malaysia/20251207/282492895014630

By Dr SITARAMARAO NAGESWERARAV

7 Dec 2025

YOUR core is like Wifi – when it’s weak, everything dis­con­nects.

1 Dead bug with heel slide: 1. Lie on your back with both your knees bent at 90° in the air. exhale fully to engage the core, then bring one foot down to touch the floor. — Pho­tos: dr Sit­ara­marao nageswer­arav

A hun­dred sit-ups a day won’t give you a strong core.

That’s because the core isn’t just your abs (abdom­inal muscles) – it’s the net­work of deep muscles around your stom­ach, back and hips that keeps your body bal­anced, sup­por­ted and stable.

Your core is your body’s cent­ral sta­bil­iser, even your spine depends on it for sup­port.

Decreased move­ment or over­do­ing a move­ment, coupled with weight gain and poor nutri­tion, weak­ens the spine and con­nect­ive tis­sues, caus­ing the lat­ter to wear down.

This even­tu­ally leads to chronic lower back pain, disc her­ni­ation and poor pos­ture.

The four lay­ers of the core con­sist of:

> Deep core sta­bil­isers - the 

inner “cor­set” muscles > Super­fi­cial core movers - the vis­ible abs

> Lat­eral and pos­terior core - the core-to-hip con­nect­ors > Func­tional net­work - sup­port­ing sta­bil­isers for every­day move­ment.

A strong core:

> Keeps your pos­ture upright

and con­fid­ent

> Pro­tects your back from injury,

and

> Improves bal­ance and every­day move­ment.

When the core is weak, the spine loses its nat­ural brace.

Spinal seg­ments start to shear and com­press, lead­ing to chronic lower back pain, disc her­ni­ation and poor pos­ture.

Your pos­ture is a mir­ror of your health, so pay atten­tion to it!

Other effects include:

> A roun­ded upper back (kyphosis)

> Pel­vic tilt or exag­ger­ated lumbar curve

> Core inhib­i­tion and glu­teal amne­sia (yes, your butt can “for­get” how to work).

The longer you sit, the more your core muscles dis­en­gage, caus­ing your brain to “for­get” about them.

From the age of 35 onwards, muscle mass begins to decline.

The deep sta­bil­isers, such as the trans­versus abdominis, are often the first to weaken because they’re rarely activ­ated in daily life.

Even reg­u­lar gym-goers tend to train what they can see (e.g. arms, chest and legs), rather than what they can feel (e.g. the deep core).

However, you don’t need fancy machines to train your core. Try this instead:

> Tighten your abdom­inal wall (like bra­cing for a gentle punch) while walk­ing, climb­ing stairs or car­ry­ing gro­cer­ies.

> Sit tall, walk upright and stretch for five minutes every half-an-hour of sit­ting. Small adjust­ments in breath­ing and pos­ture make a big dif­fer­ence.

Two other power­ful core exer­cises you can do at home are:

> Dead bug with heel slide (deep core repat­tern­ing)

This exer­cise tar­gets the trans­verse abdominis, pel­vic sta­bil­isers and deep spinal flex­ors.

It retrains coordin­a­tion between the dia­phragm, core and your pel­vic floor – all cru­cial for pos­ture and spine sup­port. > Half-kneel­ing pal­lof press (rota­tional sta­bil­ity for real life)

This exer­cise tar­gets the obliques, mul­ti­fidus, glu­teus medius and trans­versus abdominis.

It builds anti-rota­tion strength – the body’s defence against twist­ing stress dur­ing daily activ­it­ies.

As uncon­ven­tional as these moves may seem, they’re backed by solid research and proven to improve func­tional strength and pos­ture.

The core doesn’t age – we do. Train it now or pre­pare to make friend­ship brace­lets with your chiro­practor later.

Dr Sit­ara­marao Nageswer­arav is a gen­eral prac­ti­tioner (GP) and cer­ti­fied fit­ness trainer. This is the first of a three-part series, which will be pub­lished fort­nightly. For more inform­a­tion, email star­health@the­star.com.my.

The inform­a­tion provided is for edu­ca­tional and com­mu­nic­a­tion pur­poses only, and should not be con­sidered as med­ical advice. The Star does not give any war­ranty on accur­acy, com­plete­ness, func­tion­al­ity, use­ful­ness or other assur­ances as to the con­tent appear­ing in this art­icle. The Star dis­claims all respons­ib­il­ity for any losses, dam­age to prop­erty or per­sonal injury suffered dir­ectly or indir­ectly from reli­ance on such inform­a­tion.

7 Great Core Strengthening Exercises - Ask Doctor Jo  

896,950 views 22 Mar 2018

Core strengthening exercises are great for improving your core strength. They can help prevent injury, increase core stability, and improve balance. I start with some beginner core exercises & then progresses to harder ones. More core exercises:    • Swiss Ball Core & Back Strengthening Exerc...   Progress through these core strength exercises at your own pace. If this is your first time doing core exercises, you may not be ready for the last ones yet. It's better to do the easy ones first and then see how you feel the next day. The first exercise is a pelvic tilt. This is great to get the core moving, and strengthening the whole pelvic area. The second core exercise is going into a bridge. This not only works your core, but it also works your glutes and hamstrings. If two legs are easy, you can do them with one leg at a time. The third exercise is with a Swiss or therapy ball. A prayer plank on the ball is a great way to activate your core. You can do this modified or a full plank. Next you will do a trunk rotation lying down with your feet on the ball. This is great for your oblique muscles. You can also do the trunk rotation seated on the ball. Using a weight will give you an extra workout, but you don’t have to use one. Now for some harder ones for core strengthening. This one is in tall kneeling, and you will lean back slightly. You can have someone hold onto your feet, or you can place them under something for support. When you are ready, you can do them without any support. This works your core, glutes, hamstrings, and quads. Finally you will do a standing march with elbow tap. You can do this on the same side or opposite sides. Try not do bend your back forward, and use your core to lift your knees. Related Videos: Back Pain Core & Back Strengthening Exercises:    • Back Pain Core & Back Strengthening Exerci...   Exercise Ball Core and Back Strengthening Exercises (Moderate):    • Exercise Ball Core and Back Strengthening ...  

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Plaque in the neck, Cleaning out the carotid artery

 

Cleaning out the carotid artery

A carotid endarterectomy is a surgical procedure to remove plaque from this important artery that supplies the brain, without which, a stroke could occur.

A STROKE occurs when an artery that carries oxygen and nutrients to and within the brain is either blocked by a clot or bursts.

The most common type is an ischaemic stroke, which is caused by a blood clot or fatty deposits (plaques) blocking or narrowing an artery (resulting in stenosis).

Meanwhile, an haemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures.

Sometimes, there may only be a temporary disruption of blood flow to the brain.

This is known as a transient ischaemic attack (TIA), where symptoms are momentary and resolve on their own in a few minutes, or at most, within 24 hours.

The symptoms – similar to a stroke – include sudden numbness or weakness in the face, arms or legs on one side of the body, trouble speaking, vision problems in one or both eyes, dizziness, and loss of balance resulting in a sudden fall.

Often referred to as mini stroke, a TIA is actually a warning sign of a future stroke, but because the symptoms are brief, people usually just shrug them off.

A shocking discovery

This is what happened to Indonesian businessman Eddy Giantono, 74, who experienced sudden weakness on his left arm, but felt fine subsequently.

He thought nothing of it, but mentioned the incident in passing to his family members.

While Eddy is not a smoker, he has been on medications to manage his high cholesterol, high blood pressure and diabetes for the past 20 years.

In addition, he suffered a heart attack 12 years ago and had to undergo heart bypass surgery.

Due to his medical history and noting that he was getting weaker, his family immediately took him to consult a doctor in Yogyakarta, where they live.

“The doctor said I had suffered a mild stroke (TIA) and there were many blockages in my carotid arteries (blood vessels that extend from each side of the neck to the skull).

“He recommended putting stents in, but since my heart bypass surgery was performed in Penang, I decided to seek a second opinion there as I have more confidence in the Malaysian healthcare system.

“Here I was told both my carotid arteries were blocked by 95% and 75% respectively, and I needed surgery.

“My doctor then referred me to another private hospital in Klang, Selangor,” recalls Eddy in a recent interview.

Removing the plaque

Treatment options to treat a blocked carotid artery depend on the severity of the blockage.

They typically involve a combination of lifestyle changes, medication, and medical procedures or surgery.

A blockage in the right carotid artery primarily affects the left side of the body.

This is because the brain has a “crosswired” structure, meaning the right side of the brain controls the left side of the body and vice versa.

As Eddy was a high-risk patient, he was advised to do a carotid endarterectomy on the right side.

As the block in the left carotid artery had not caused any symptoms, his doctor, consultant vascular and endovascular surgeon Dr Yow Kuan Heng, decided to take a wait-and-see approach.

A carotid endarterectomy involves making an incision in the neck, opening the carotid artery and physically removing the plaque build-up before the artery is stitched closed, often with a patch to widen it.

“Initially, my father wanted to postpone the operation as I was getting married, but the surgeon firmly said no as he was in danger of getting a stroke that could be fatal.

“So although he is a stubborn man, he had no choice but to agree,” says daughter Anatasya Giantono.

The surgery, carried out in August, was successful, and Eddy was already walking the next day, determined to go home as he didn’t want to change Anatasya’s wedding date.

“Even when he was in the intensive care unit, he insisted on being discharged,” she says, laughing.

“He gets homesick easily and doesn’t like being away for long periods.”

A week after he returned home, Eddy proudly walked his firstborn down the aisle. No one could tell he had recently undergone a complicated surgery.

Today, Eddy says he is “sihat sekali” (very well) except for speaking with a

slight lisp, which Dr Yow has said will normalise in time.

The surgical scars at his neck are fading fast and he has resumed his normal routine.

Thanks to early intervention, Eddy was most likely saved from a major stroke in the nick of time.

Get assessed quickly

Atherosclerosis – the thickening or hardening of the arteries caused by a build-up of plaque in the inner lining of an artery – can affect almost any artery in the body, including those in the heart, brain, arms, legs, pelvis and kidneys.

If the build-up is in the neck, it is called carotid artery disease; in the heart, it is coronary artery disease, in the leg, it is peripheral artery disease, etc.

According to Dr Yow, carotid stenosis from narrowing in the neck area is the fastest rising cause of ischaemic stroke in the world, particularly in the Asian region.

“Traditionally, doctors from this region felt that most strokes were happening in the skull, but that pattern has now changed due to the diabetic pandemic.

“The risk of a stroke is greatest when the narrowing in the neck is higher than 50% (classified as critical carotid stenosis).

“If there is a major stroke, you need drugs to break up the clot, but for TIA, you need to see a vascular surgeon as soon as possible to get assessed by scans,” he says.

A TIA is usually an indication of an unstable plaque in an artery supplying the brain, which can rupture at any time and cause a blood clot to form.

This clot can then break off, travel to the brain and block blood flow, leading to a stroke.

“It is important for the public to know that carotid endarterectomy is the firstline treatment for symptomatic carotid stenosis.

“In surgery, you immediately clamp the artery before opening it up, but in stenting, you have to push a guided wire through a hot zone of clot.

“That process, even with protection devices or filters, has a higher rate of stroke than surgery,” explains Dr Yow.

He adds: “In Eddy’s case, after discussions with my multidisciplinary team, we decided to operate only on the side that was symptomatic because he has moderate heart failure.

“Since he had no symptoms on the left side, we didn’t touch it.

“If he develops symptoms in future, then we have to think about surgery.”

He emphasises that physiotherapy must be done as soon as possible after surgery, and on average, patients are discharged from hospital by day three.

A repeat scan of the repaired carotid artery is carried out six weeks after surgery.

So, if you experience a TIA, head to the doctor as soon as possible and request for a carotid artery ultrasound or computed tomography (CT) angiography.

Don’t delay as every minute can make a difference.

By REVATHI MURUGAPPAN starhealth@thestar.com.my

Related article:

Carotid artery disease - Symptoms and causes

Mayo Clinic

https://www.mayoclinic.org › syc-20360519

24 Jul 2025 — Carotid artery disease occurs when fatty deposits, called plaques, clog the blood vessels that deliver blood to the brain and head (carotid ...

Diagnosis and treatment

Carotid angioplasty and stenting

Does my cough mean I have pneumonia?

 

Pneumonia can be a potentially life-threatening infection, especially for vulnerable groups, and a cough is one of its common symptoms.

People who have pneumonia tend to have a productive cough, i.e. one that produces mucus or phelgm. — dpa

Coughs and colds are rife this time of year, but how can you tell when they might be a sign of something more serious, like pneumonia?

Recognising the difference between an ordinary cough and a potentially dangerous lung infection can play a crucial role in ensuring timely treatment and a smooth recovery.

To help clarify the signs, we spoke to British consultant general practitioner (GP) Dr Claire Agathou, who explained exactly what pneumonia is, what its key symptoms are, and when to seek medical advice.

What is pneumonia?

“Pneumonia is an infection of the lungs which causes inflammation in the tiny air sacs in the lungs, which are called alveoli, which then fill with fluid or pus,” Dr Agathou explains.

“This makes it much harder for oxygen to pass into the bloodstream, which leads to coughing, breathlessness and fever.

“It can affect just one lung, or sometimes both, and ranges from mild to life-threatening.”

According to British charity Asthma + Lung UK, there were 518,525 hospital admissions for pneumonia alone in England last year and almost a fifth of these patients were readmitted again after 30 days

What causes it?

“Pneumonia is most often caused by bacteria called Streptococcus pneumoniae, but viruses, and less commonly, fungi, can also trigger it.

“We often call this an atypical pneumonia,” says Dr Agathou.

“Pneumonia can develop after a viral illness like a flu when the immune system is really run down or when bacteria is inhaled into the lungs.”

How can I tell if my cough is likely to be from pneumonia versus from a viral infection or allergies? Are there any key differences to look out for?

“Typically, a more viral or an allergic cough tends to be on the drier side.

“Sometimes, if it’s viral, it’s also linked to a sore throat or feeling a bit congested, and usually improves itself after a week or two,” she says.

However, Dr Agathou highlights that pneumonia coughs are typically “productive”, i.e. bring up mucus or phlegm.

“If you’re bringing up green, yellow or rusty-coloured phlegm, start to feel very feverish and experiencing any breathlessness, those would be the sort of things that would start to make you think it might be pneumonia,” she says.

“You will generally feel more unwell and weak with a pneumonia than you would with a simple cold or hay fever-like symptoms if it was allergy-related.”

Are there any other key symptoms to look out for?

“Another big thing to look out for is chest pain, or pain when breathing in,” highlights Dr Agathou.

“Another common symptom that we see, particularly in older adults, is confusion.

“In addition, when you’ve got pneumonia, you may pass much less urine and tend to be dehydrated, so these are some other things to look out for.”

Who is more at risk?

“It is possible for anyone to develop pneumonia and many healthy adults recover well with antibiotics,” says Dr Agathou.

“However, the rates are much higher in vulnerable communities, so, in the elderly or people with reduced immune function or respiratory conditions.

“It’s really important that babies, the elderly or those with chronic conditions, weaker immune systems or respiratory conditions displaying symptoms are seen to very promptly.”

When should you go to a GP about your symptoms?

“If you’ve got a cough that’s just lingering and persisting after five to seven days, you should be seen by a doctor,” she advises.

“But, irrespective of time frame, if you have a really severe cough, feel really unwell and start to feel that your breathing is off the norm, then I would get checked out very quickly by a GP.

“If there is a pneumonia there, we want to treat it as soon as possible when it’s mild, to prevent you from getting much worse.”

How is pneumonia diagnosed?

“When you go to a GP, we check your oxygen levels, your breathing rate, your temperature, your pulse and all of these things that can indicate to us how severe the infection is,” explains Dr Agathou.

“We also listen to your chest to see if we can hear anything unusual and if we are very concerned, we can organise an X-ray.”

How is pneumonia treated and managed?

“If it’s a typical pneumonia, antibiotics and fluids are the primary sources of management,” she says.

“Oral antibiotics are usually prescribed, provided that the person is able, is not vomiting, and is in a suitable condition to be managed at home.

“However, the most severe cases need hospital care, oxygen support and fluid.”

Why are people more susceptible to pneumonia in the colder months?

“In the colder months, our immune systems are working harder because of the stress from a cold response, and also because infections tend to spread more,” says Dr Agathou.

“We also know that flu is more common in the winter months, and when people have flu or viruses, it means their immune systems can be weaker and that’s why you’re more susceptible to getting pneumonia.”

Are there any ways to prevent yourself from getting pneumonia?

“It is all about making sure that your immune system is kept as strong as possible,” she says.

“For example, doing things that can help us fight infection better, like making sure you’re dressed warmly and taking multivitamins.

“In addition, if you are eligible for the flu and/or Covid-19 vaccine, you should consider having these.” – By Camilla Foster/PA Media/spa 

Boosting your metabolic rate

“More than half of the body’s “More than half of 

“More than half of the body’s metabolism is used as basal metabolism.”

Dr Faridah Mohd Zin

28 Sep 2025

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Increase Metabolism At Any Age (7 Tips)

INCREASING metabolic rates has been of interest to many, especially among weightconscious individuals. Understanding metabolism is crucial in guiding us to obtain an optimal metabolic rate. Metabolism is the conversion of energy intake i.e., food consumption into products including energy and waste products. Increasing the rate of conversion is believed to burn off body fat. But is this true?

MSU Medical Centre (MSUMC) health screening and wellness specialist Dr Faridah Mohd Zin explains, “Our body consumes energy in four pathways: basal metabolism, food thermogenesis, non-exercise activities thermogenesis (NEAT) and exercise activities thermogenesis (EAT). More than half of the body’s metabolism is used as basal metabolism, which supports the function of vital organs such as the heart, kidneys, brain and others (about 60%).

The thermic effect of food has the lowest contribution which involves the energy needed to change the food we eat into substances that are “edible” by our cells i.e., glucose (about 10%). Increasing the metabolic rate would mean increasing the energy-burning rate of the body which theoretically could be increased by optimising the NEAT, EAT, thermic effect of food and body metabolism.

NEAT is simply the energy consumed when performing daily activity. Optimising daily activities such as cooking while standing or pacing around the room while on the phone has been shown to increase metabolic rates. Since these activities will naturally be done every day, enhancing the energy burned through this pathway could be regarded as an opportunity that should not be missed. Moreover, NEAT is found to be associated with improvement in overall health and helps in body fat reduction.

EAT is the body’s energy consumption through structured exercise which primarily includes cardiovascular, strengthening, flexibility and balance. Furthermore, each type should have specific criteria in terms of frequency, intensity, time and types (FITT approach) to achieve different exercise objectives. For example, in maintaining fitness, a total of 150 minutes of cardiovascular exercise per week is recommended while a longer duration is needed for body weight reduction.

Food thermogenesis contributes the least to body energy consumption. High lean protein and whole food use more energy in the metabolism compared to other types of food and processed food. Although eating the former would induce higher thermogenesis hence a higher metabolic rate, the contribution made in the increment of daily body metabolism is the lowest.

The major factors contributing to the basal metabolic rate include sex, height, age, ethnicity, body composition and genetic factors. While the body compositions are mainly composed of the vital organs, bones, body fat and muscle mass, the latter two are the only factors that can be intentionally changed.

Total body fat is composed of essential and storage fat. Storage fat is mainly deposited under the skin as subcutaneous fat, or around the body organs as visceral fat. The latter has been strongly linked to an increased risk of cardiovascular diseases including heart attack and stroke. Energy consumption of more than required would be stored in the body as fat. Hence, a negative balance between energy intake and consumption is essential to force our body to use up the storage fat as a source of energy, leading to weight reduction. Since storage fat originates from food intake, altering an individual’s diet is crucial for achieving the desired body fat level.

Increasing muscle mass would increase the ability of the body to use up energy. The American College of Sports Medicine recommends regular resistance training exercises as the key to building and keeping muscle. Men and women should participate in muscle-strengthening activities that work the major muscle groups (legs, hips, back, chest, abdomen, shoulders and arms) at least two times each week. Examples of muscle-strengthening activities include lifting weights, using resistance bands, doing push-ups and some types of yoga. Even everyday activities such as gardening, playing with your kids and carrying groceries can strengthen muscles.

Although resistance training is an important part of a complete exercise regimen, consuming the appropriate amount and type of protein to maintain and build muscle is just as important. On top of that, a healthy balanced diet is crucial to ensure adequate macroand micro-nutrients needed for a healthy body.

Body metabolism happens continuously, allowing ongoing opportunities to maximise its effect. Body fat is a way for our body to store unused energy. Hence, optimising the body’s metabolism while consuming less than the daily energy requirement will force the body to burn stored fat for energy. Consistently maintaining this negative energy balance will gradually reduce unwanted fat.