Physical Wellness Among First Generation South Asians
Since 1948, the World Health Organization has had a multifaceted approach to what constitutes health and the popularity of the term wellness arose in the 1950s. While the 20th century was a pivotal time, so was the immigration of South Asians to the United States during the late 1980s. First generation immigrants were seeking better opportunities in order to progress within their education, careers, and overall standard of living — and the importance of preserving culture was high, which in turn also had an impact on health and lifestyle. Compared to past decades, the South Asian community in the US is currently hitting a turning point in terms of their awareness about what defines a healthy lifestyle.
If we take a look at the wellness wheel which encompasses seven values, South Asians on average are known to put greater societal value into social, occupational, spiritual, and intellectual aspects and are often lacking in the physical, emotional, and environmental aspects of the wheel. Specifically, the lack of physical wellness continues to be high within our community and is a reason for why South Asians are at an increased risk for chronic illnesses. While there may be a multitude of barriers that interfere with progress, as second generation South Asian Americans, we must take on a role to increase awareness of what the most common misconceptions are within our community and form possible solutions to help promote improved physical wellness for our first generation immigrant parents.
Part 1: Most Common Misconceptions
- “Eating healthy means I’m not going to be able to eat Indian food again.”
This is often the common fear and several nutritionists and health experts have proven that this would not be sustainable long term. Shwetha, a certified personal trainer and PN1 Nutritionist states:
“I’ve always told others that before cutting your favorite foods, try something simple. Such as reducing the rice and increasing the protein and vegetables on your plate. It’s about changing how you eat versus what you eat.”
It can start off with something as straightforward as this in order to get our parents more in the mindset of portion control and understanding whether they are getting adequate amounts of carbohydrates, protein, and fats. Starting here can get them motivated to be aware of how there are several variations to how a plate may look, and MyFitnessPal has recommended dietary guidelines that can be followed as an option.
Now, this may help segway into understanding different aspects of what a traditional daily South Asian diet is commonly composed of, such as: high carbs, high sodium, and high saturated oils. Possible alternatives or changes to the daily traditional diet and the resultant health outcome goals are listed in this table below:
There are several factors involved that contribute to which diet would work best for our parents, and so the table above only touches the surface of what changes could be made. When trying to find a specific plan that works best, it would be helpful to seek a nutritionist who has an expertise in the South Asian diet in order to help make appropriate modifications based on comorbidities. There are also additional resources such as Dee Gauthman’s Fit Desi Food Guide which provides several recipes that can serve as a great aid to diet planning.
So don’t be fooled with what others say, as one can still very well keep Desi food at the top of the chain, just with some portion modification and fun tweaks.
2. “I walked today. That’s enough exercise.”
As a physical therapist, we educate that although cardiovascular related activities such as walking is essential in order to help reduce the risk for heart disease, stroke, and diabetes, it’s not the only form of exercise that should be considered.
Strength or resistance training is crucial in maintaining bone mineral density (BMD) and reducing the risk for osteoporosis, a metabolic condition which is common among South Asian women, which can result in subsequent fractures that can most commonly occur within the spine and hip. Not to mention, we should be aware about Arthur (Arthritis) sneaking up on us at some point down the line. Strength training should be incorporated at least two times per week and would additionally aid in improving joint stability, while trying to reduce the number of times Arthur may be playing his games on us.
To South Asian females who have a fear of developing a more muscular physique similar to a male from strength training: it would rather create more lean body mass, reduce body fat, and create increased muscle tone that will help reduce the risk for chronic musculoskeletal disorders down the line.
For our parents in the 60+ group, there are a ton of options out there that we can help them find. This can range from the following:
- YouTube at home strengthening workouts
- Fitness apps (SilverSneakers Go, J&J 7 Minute Official Workout, Pilates Anytime)
- Fitness classes (Water aerobics, pilates, strengthening: body weight, resistance bands, dumbbells, etc.)
While all of these options are available, it’s important to seek medical advice prior to partaking if you feel that your parent has certain medical conditions that can put them at risk for injury.
Lastly, let’s not forget that while walking is a great dynamic activity, it does not challenge our sensory (balance) organs enough, especially for the community dwelling older adults (>60 years). Visual decline can occur starting at the age of 50 with difficulty maintaining adequate depth perception or accommodation and balance is 80% reliant on vision. So when one or multiple aspects are impaired, older adults may have a difficult time overcoming hurdles, steps, and curbs, which may put them at a higher risk for falls.
If you notice that your parent may be at a risk for falls, seek a physician consultation. Appropriate falls risk assessment screens should be completed by health care providers, and balance rehabilitation and subsequent maintenance is recommended to this population in order to enhance their overall functional independence. To further understand falls risk screening and assessments, the CDC’s STEADI (Stopping Elderly Accidents, Deaths & Injuries) Algorithm for community dwelling adults >65 years can be found here.
Part 2: Sociocultural Limiting Factors
- Language barrier
Dilpreet, a certified personal trainer expresses that:
“It’s easy for us to tell our parents to go to the gym. A lot of them don’t know how to exercise and so it starts with us teaching them. Because of this, I have created ‘how to’ videos in Punjabi on common exercises to allow them to feel a sense of comfort in their own homes prior to going to a gym.”
As Dilpreet mentioned, our parents need to first feel comfortable in the environment they are in even if that means starting an exercise routine at home. Especially for those who have a language barrier, it’s important that kids seek appropriate resources for their parents which would be the most appropriate in helping them with their performance. Therefore, having them begin with exercises in the particular language they are fluent in would be a great start.
For Dilpreet’s step by step exercise guide in Punjabi, click here.
2. Fear avoidance due to chronic pain
Fear avoidance behavior or catastrophic thinking can commonly develop when people are experiencing chronic pain, where the fear of increased pain itself can result in not participating in physical activities. This is prevalent among several South Asians, as there is a social stigma with performing exercise while recovering from an injury. While a number of research studies have shown the effects of pain neuroscience education, graded motor imagery, and cognitive behavioral therapy as options for therapy, graded activity exposure has proven to be the most beneficial in order to help reduce fear avoidant behaviors.
With mental health continuing to be overlooked within our community, and while our parents may not open up about their fears, it’s important that we take initiative and ask them. It can start off as simple as having us expose them in a step by step fashion to the challenging task at hand. I followed this model with my mom, and it allowed her to return to feeling more confident with lifting objects while she does household activities.
Such a task may seem basic to us who are fortunately functional, however to someone who feels intimidated by this, this will feel like a multi-step process that requires more re-education to their muscles and neural pathways.
The goal of breaking up tasks this way just shows that it can be performed with any physical activity our parents fear or struggle performing, though it starts with us acknowledging what those activities are in the first place. From there, we should make sure that they are safely refining their skills with the new activity that they are participating in.
3. Fitness not fitting in with Desi lifestyle
A handful of first generation South Asians want to preserve the culture that they immigrated to the US with and often see fitness as a part of the American culture. Subconsciously and for this reason, many feel hesitant about the practice of fitness as they don’t know where it blends in with the South Asian culture, however it could be due to the fact that they have not yet been exposed to the right fitness community yet.
Sarika, the creator of Rhythm & Tone Dance Cardio states that:
“Both non-Indians and Indians love Bollywood and I have seen that R&T brings a sense of familiarity and community. It’s been great to be a part of helping people feel more familiar with the culture that they may not resonate with or what they want to experience more of in their lives.”
This serves as a great example for those parents who have always wanted to try combining both fitness and dance worlds into one, even if it is just for fun.
Umama, the founder of SweatPack also reports:
“When I built SweatPack, I thought about my dad. He played cricket and other several sports in Bangladesh, however after moving to the US, he couldn’t find that same community that was keeping him active. A major goal for SweatPack was therefore to take pockets of different generations and bring them together with common fitness or activity related goals while keeping them consistent.”
South Asian immigrants highly value the importance of community and with this mindset, it can make it that much easier to build fitness communities that they feel more at home with. Food for thought in terms of what we need to continue to strive for is building first generation South Asian fitness network groups, so our parents are part of a larger community who values physical wellness long term, while also feeling connected to their culture.
