By SumarbinUmdor
Today is National Sports Day and on this occasion our Prime Minister, Narendra Modi is launching a Fit India Movement to raise awareness and encourage everyone, young and old, to incorporate physical activity and exercise in their daily routine which would go a long way in improving the health and well-being of all citizens. As a fitness enthusiast I couldn’t agree more with our Prime Minister and congratulate him on putting the spotlight on the importance of fitness for modern India. The authors of a scientific paper, ‘Effects of physical inactivity on major non-communicable diseases (NCDs) worldwide’ published 2012 in The Lancet point to strong evidence that physical inactivity increases the risk of many adverse health conditions, including coronary heart disease, type 2 diabetes, breast and colon cancers and other chronic diseases. It also concluded that about 9% of premature death is a result of physical inactivity.
India’s burden of NCDs is escalating as cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, depression and other NCDs are estimated to account for about 60% of all deaths in the country much more than those caused by communicable diseases, injuries and other conditions. In the past chronic diseases were associated with older populations, however because of lifestyle shifts they are now becoming more prominent in younger adults leaving them burdened with health care concerns for the rest of their lives. In India the onset of NCDs is a decade earlier (45 years and above) than in developed nations which has implications on economic growth and productivity. A report by the World Economic Forum estimates that India stands to lose about 3.5 trillion dollars between 2012 to 2030 due to NCDs and mental health conditions.
NCDs are often a direct result of lifestyle and environmental factors and some of the modifiable behaviour such as harmful consumption of alcohol, tobacco use and unhealthy diet combined with sedentary lifestyle and lack of physical activity all contribute to the risk of chronic diseases. Physical inactivity is heavily correlated with the development of many diseases particularly cardio vascular diseases (CVD). This relationship is supported by many epidemiologic studies starting with the ground breaking work by Morris in 1954 who found that, the more active bus conductors were less likely to suffer from CVD than the inactive drivers. According to WHO estimates over 30% of cancer cases are preventable by incorporating a lifestyle that includes physical activity and regular exercise. Other studies have reported increased physical activity and exercise as being associated with decreased risk for breast cancer, colon cancer, and prostate cancer. Similarly, there is large body of evidence showing the benefits of exercise in the primary and secondary prevention of diabetes, hypertension, depression, osteoporosis and dementia. The benefits of exercise goes beyond health benefits as regular physical activity also helps to maintain an individual’s high functional capacity for much of his/her life avoiding deficient survival which is a state where someone is alive but not really living because low functional capacity.
While much attention is given to prevention of NCDs by way of treatment strategies not much focus has been put on the prevention aspect in terms increasing physical activity as part of battle against chronic diseases. Today physical activity and exercise is widely recognized as a means for the primary prevention (or delaying the onset) of chronic diseases as well as in patients’ treatment and rehabilitation, so much so that the expression, ‘Exercise Is Medicine,’ is gaining wide credence as being as effective as drugs in preventing death from chronic diseases afflicting mankind. In fact the benefits of exercise go beyond medicine as it is free and has little or no side effects. So then what constitutes physical activity and exercise?
Caspersen and others (1985) have defined physical activity as any bodily movement produced by skeletal muscles that require energy expenditure, and that exercise is a subset of physical activity. Exercise involves physical activity performed during leisure time with the primary purpose of improving or maintaining physical fitness, physical performance, or health. Brisk walking, jumping rope, dancing, playing tennis or soccer, lifting weights, climbing on playground equipment at recess, and doing yoga are some examples of health-enhancing exercises.
The World Health Organization global recommendations on physical activity for adult individual without any specific medical condition state that (i) adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate and vigorousintensity activity. (ii) Aerobic activity should be performed in bouts of at least 10 minutes duration. (iii) For additional health benefits, adults should increase their moderate intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate and vigorousintensity activity.(iv) Muscle strengthening activities should be done involving major muscle groups on 2 or more days a week.
Most individuals that follow some recreational physical activity tend to focus mostly on aerobic exercises such as walking, jogging, running, cycling, swimming, etc., exercises that contributes to cardio-respiratory fitness. There is not much awareness about the importance of strength training or resistance training, stretching and balance exercises particularly among older adults. As we age our body experience a number of physiological and functional declines such as loss of muscle mass and strength that contribute to increased disability, frailty, and falls.
A study published in the American Journal of Preventive Medicine (2003) reports that strength training exercises when done regularly build muscle strength and muscle mass and preserve bone density, independence, and vitality with age which helps to combat weakness and frailty and their debilitating consequences. In addition, strength training also has the ability to reduce the risk of osteoporosis and the signs and symptoms of numerous chronic diseases such as heart disease, arthritis, and Type- 2 diabetes, while also improving sleep and reducing depression.
It is therefore vital that an exercise plan should outline how often (frequency), how long (time), and how hard (intensity) and what kinds of exercises (type) are necessary and selected according to the individual current status of one’s health level and fitness goal. The exercise frequency, intensity, time, and type also known as FITT principle, should be key components of any fitness routine. For example, any exercise plan should incorporate both aerobic and strength training routine in the frequency and intensity as laid down in most physical activity guidelines.
A recent study titled, ‘Physical activity and inactivity patterns in India – results from the ICMR-INDIAB study’ (2014) reported that nearly half of the population in the country are inactive and further that leisure-time or recreational physical activity levels are extremely low in India with more than 90% of individuals in both urban and rural areas reported doing no recreational physical activity. The report also highlights that even among those who reported recreational physical activity, the time spent in moderate to vigorous intensity activity was overall less than 20 mins/day, much lower that the recommended target.As physical activity levels in the occupational domain decline, individuals will have to obtain much of their physical activity requirements through recreational physical activity. This therefore underscores the importance of the Fitness India Movement being launched today and calls for individuals and institutions to join hands in creating increased awareness regarding the dangers of physical inactivity and encouraging everyone to actively engage in recreational physical activity for their physical and psychological well-being.
(The writer is a fitness enthusiast and can be contacted at [email protected])