One would think it is nearly intuitive that exercise has great benefits for human health, but things are seldom that simple. In addition to the ‘feel good’ one derives from exercising, evidence-based intervention is key, so the hunt is constantly on to prove certain truisms, repeatedly, endeavouring to constantly advance the envelope.
A recent study anchored by the University of Sydney showed that regular physical activity, of moderate to vigorous intensity, was inextricably linked to a lower risk of Type 2 diabetes (T2D), even among individuals who had a genetic predisposition towards the metabolic disorder. The results were published in a recent issue of the British Journal of Sports Medicine.
The WHO recommends at least 30 minutes of moderate-intensity physical activity per day for the prevention of T2D. Authors of the paper Mengyun Luo et al, argue that ‘such recommendations almost exclusively rely on studies using self-reported measures of physical activity, which is subject to bias.’ They decided to study the dose-response association between device-measured physical activity, and T2D, and further map the interaction between genetic risk and physical activity on T2D. The study was based on 59,325 adults whose intensity-specific physical activity was collected using accelerometers.
Researchers reported that those engaging in more than one hour of moderate to vigorous physical activity in a day, had a lower chance of getting T2D even if they had a genetic predisposition. “During a median follow-up of 6.8 years, there was a strong linear dose-response association between moderate-to-vigorous-intensity physical activity and incident T2D, even after adjusting for genetic risk.” In the final analysis, the most active group had a 68% lower risk of developing T2D.
“Exercise definitely has an effect, particularly among those who have a genetic predisposition to getting diabetes. We recommend weight loss through calorie restrictions, and physical exercise routinely for our patients,” says V. Mohan, chairman, Madras Diabetes Research Foundation. He adds that over the years, the definition of ‘ideal exercise’, if there is such a thing, has been mutating, and today the recommendation is to even exercise for 15 minutes three times a day. The in thing is walking after dinner. “It does have a profound effect on blood sugar management,” he says.
Lakshmi Sundar, lifestyle medicine specialist, believes in practicing what she preaches. Lifestyle has a definite and decisive role to play in the prevention, and management of metabolic disorders, she says. “I’m an example for how someone who had very little association with sports or even physical activity can take up, and enjoy, rigorous activity, even if they start later in life.” Her tale, then, is truly inspirational. A congenital cardiac anomaly put paid to any aspirations of physical activity in childhood, but today she’s a regular runner, and lifts heavy in the gym.
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“It actually started when I was 47. I had been very sick, and from a scrawny youngster I had put on a lot of weight, getting to overweight, not able to walk 500 metres without a wheeze. Everyone said that I could not exercise because of my condition, but I slowly started to walk, signed up for a competition, and completed the race,” Dr. Lakshmi explains. From there, there was only progress in her journey with working out and today, she says, it helps with everything. However, she underlines the fact that she did everything scientifically, having to take care of multiple aspects.
Among the things that have found a significant place in the formula she has for a healthy life, is also a diet. She has chosen a dietary pattern that seems to work well for her because she her motto is: “ Good exercise cannot outdo poor diet”.
For R. Manoj, a corporate executive in Chennai, hitting 50 was like a wake-up call. Wedded to his profession, working impossibly long hours at the office across time zones, obesity, compounded with a diet that was least healthy, awry meal times, and lack of adequate sleep, hustled him towards diabetes and hypertension by the time he hit the big 5.
His diabetologist suggested he start by losing weight, working with a combination of diet and vigorous exercise. “Shedding 25 kilos over a period of several months was not the easiest thing I did, but it was probably the best thing I did for myself. I worked really hard with a trainer, and a dietician and a yoga teacher- they gave me schedules suited for my targets. In my latest review, the blood work is near perfect. The blood sugar count is within acceptable limits, and blood pressure readings are consistently good,” says a beaming, slimmer Manoj.
Dr. Lakshmi says that a good diet and exercise are twin mantras. “Calorie reduction has to stop at some point of time. One can’t keep reducing calories consumed non-stop. The trick is to balance that with exercise, what I recommend is walking or running 3/4 days a week, and 2-3 days of strength training. The later helps build muscle, which helps the muscle utilise the stored blood glucose better, leading to lower blood glucose,” she adds, and also adds a word about exercise helping women who are menopausal to manage weight gain, hot flushes and mood swings.
However, it definitely costs to be ‘healthy’ and stay that way, Dr. Mohan points out. The world over, the cheapest foods are probably less healthy and with exercise becoming a casualty of the modern sedentary lifestyle, risks factors for non communicable diseases are on the increase. “Some one who is poor cannot afford to have a trainer or may not even have time to properly work out. The best way to address this would be to have adequate public spaces (parks, playgrounds) to walk and/or exercise.
He points to the success of the Asiad Colony experiment, which showcased local efforts to create enabling environments for walking that had borne positive results for the community. After an epidemiological study showed a high prevalence of diabetes in a Chennai-based community, the people there were encouraged to do something about the need for physical exercise. They pooled resources and created a park where they could regularly exercise. Follow up studies indicated an ameliorative impact of exercise on health parameters for the members of this community.
Shashank Joshi, endocrinologist and president, Indian Academy of Diabetes, believes that India should have its own physical activities guidance ‘as we are sarcopenic -meaning less muscle mass or thin fat’. He explains: “Our guidance includes 60 minutes of daily physical activity with all 3 - aerobic, muscle strengthening resistance exercise and NEAT (non exercise activity) thermogenisis (defined as that ‘portion of daily energy expenditure resulting from spontaneous physical activity that is not specially the result of voluntary exercise’). This means we have to move more, and be more ‘fidgety’. Traditional yogic practices including practices like surya namaskar did incoporate some of this.” However, he is very clear that there is a need to generation proper evidence, through randomised control trials, in this area.
Ask him for his favourite mantra, and Dr. Joshi spontaneously says: “Eat less, eat slowly and on time, build muscle and move more, sleep well for at least 7 hours and smile.” And the smiling part, that is likely to happen naturally when feel good endorphins flood your brain after some really invigorating exercise, even if you are wincing right through your workout.
