| PHYSICAL ACTIVITY AND CARDIOVASCULAR DISEASE PREVENTION: FOCUS ON SOUTH ASIAN REGION |
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| Rajeev Gupta, SK Sharma, Kunal Kothari | ||||||||||||||||||||||||||||||||||||||
| Monilek Hospital and Research Centre, Jaipur 302004; SMS Medical College and Hospital, Jaipur 302004; and Mahatma Gandhi National Institute of Medical Sciences, Jaipur 302022 India | ||||||||||||||||||||||||||||||||||||||
 INTRODUCTION |
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| There is ample scientific evidence that regular physical activity is beneficial. Light to moderate physical activity in healthy adults reduces risk of premature death, coronary heart disease and strokes, development of diabetes, high blood pressure, colon cancer, depression, and anxiety. It also helps to control weight, builds healthy muscles, bones and joints, helps older adults become more active, and promotes psychological well being. The United States of America (USA) National Institutes of Health defines physical activity as "bodily movement produced by skeletal muscles that requires energy expenditure" and exercise as "a planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness". Physical inactivity denotes a level of activity less than that needed to maintain good health. |
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PHYSICAL ACTIVITY IN CARDIOVASCULAR DISEASE PREVENTION |
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| Regular physical activity favorably modifies cardiovascular risk factors of high blood pressure, blood lipid levels, insulin resistance and obesity. Several observational and interventional studies performed in developed countries of North America, Europe and Asia have shown that exercise-training programs significantly reduce overall mortality as well as death caused by myocardial infarction. The reported reduction in mortality has been the highest in formal cardiac rehabilitation programs (about 25%) that also focus on control of other cardiovascular risk factors. It has been shown that there is a quantitative relationship between level of activity and magnitude of cardiovascular benefit. The benefit extends across the full range of activity. A moderate level of physical activity confers optimum health benefits but this activity must be performed frequently to maintain benefit. It has been recommended that all people increase their regular physical activity to the level appropriate to their capacities and needs. The long-term goal should be at least 30 minutes or more of moderate-intensity physical activity on most or all days of the week. Intermittent or shorter bouts of physical activity (at least 10 minutes) including occupational, non-occupational, or tasks of daily living also have similar cardiovascular benefits if performed at a level of moderate intensity (e.g., brisk walking, cycling, swimming, home repair or garden-work) with an accumulated duration of at least 30 minutes per day. Physical inactivity is highly prevalent in North America and European countries. In the United States, in 1991, fifty-four percent of adults reported little or no regular physical activity. The national surveillance programs have documented that about one in four adults have no leisure-time physical activity. The prevalence of inactivity varies by gender, age, ethnicity, health status and geographic region but is common to all demographic groups. Occupational physical activity has also declined in developed nations of Europe and North America during the last century. Children become less active as they grow older. At age 12, seventy percent of children report participation in vigorous physical activity; by age 21 this activity falls to forty-two percent for men and thirty percent for women. Data from the 1990 Youth Risk Behavior Survey in the USA showed that most teenagers in grades 9-12 were not performing regular vigorous physical activity. About fifty percent of high school students reported they are not enrolled in physical education classes. |
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PHYSICAL ACTIVITY LEVELS IN SOUTH AND SOUTH-EAST ASIA |
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| Traditionally, populations in South and South-East Asia have been rural-based agrarian workers and occupational physical activity levels have been high. Rapid socioeconomic transition in this region has resulted in change of occupation from farming to formal industry-based jobs and, therefore, occupational physical activity has declined. Data to support these observations are sparse and studies performed in this part of world have not used internationally acceptable criteria to define physical activity. In India, it was reported in mid 1970's that almost all the rural men were involved in regular or irregular strenuous physical activity. This proportion declined to 70% in early 1990's and a study reported that even among farmers regular moderate intensity physical activity was in 25% men, other indulged in intermittent activity. Among women too, daily household chores that involved physical activity have declined due to mechanization of farming. Data among urban Indian populations show that moderate and high grade physical activity is uncommon. In early 1990's only 14% subjects were reportedly involved in regular non-occupational physical activity and the proportions did not change significantly over the next ten years. In Chennai urban population, about half of the population was found involved in moderate to severe occupational or non-occupational physical activity. Data from Bangalore showed that among office-going workers, although the awareness of usefulness of regular physical activity as health-promoting habit was present in more than 75% subjects, there was very low prevalence of regular moderate physical activity. Women were found more physically active than men largely because of greater participation in energy consuming household chores. In an urban population of Rajasthan, moderate intensity leisure-time physical activity increased from 14% to 22% in men. Paradoxically, this was associated with increasing obesity, truncal obesity and lipid levels possibly due to faulty nutrition practices and decline in low-grade occupational and other minor physical activity that contributes significantly to daily energy consumption. Physical activity data from other parts of South and South-East Asia are sparse. In Sri Lanka, comparison of rural-urban differences in physical activity revealed that more rural men (33%) were physically active as compared to the urban (19%). Low levels of regular physical activity are reported from other countries also. In Mauritius after five years of non-communicable disease intervention program there was an increase in leisure-time physical activity from 17% to 22% in men and 1.3% to 2.7% in women. In China, over a seven-year period regular leisure-time physical activity increased from16% to 26% in men and 9% to 24% in women. In both these instances this increase was associated with an increase in obesity, truncal obesity, diabetes and cholesterol levels. It was concluded that a decline in low-grade and occupational physical activity was the main reason. Increasing body-mass index, truncal obesity and dyslipidaemias in Thailand, Hong Kong, Singapore, Malaysia and other regions of South-East Asia could be similarly explained. Yoga exercise is a specific form of physical activity prevalent in South Asians. This form involves breathing exercises, stretching, bending, and meditation. Studies have shown that regular yoga exercises can lead to a reduced lean mass. This form of activity as part of a comprehensive lifestyle change can be advocated for prevention and progression of coronary artery disease as some randomized studies show benefit. The population prevalence of this form of physical activity is unknown. Regular physical activity is encouraged in most educational institutions in India and other countries of this region. However, no formal studies that track the physical activity levels of these children are present. |
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| RECOMMENDATIONS |
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| Regular occupational physical activity is declining in South and South East Asian populations while the non-occupational activity is very low. This change correlates well with the increasing incidence of coronary heart disease, hypertension, diabetes, obesity and other non-communicable diseases in this region. Urgent population-wide measures are required to change this scenario and it is worthwhile to emulate targets set by the US National Institutes of Health: |
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| Physical activity should begin sooner rather than later in one's life span. Parents, schools and community organizations should provide a supportive environment that encourages and integrates physical activity into daily lifestyle. Children must be introduced to the principles of regular physical activity and be provided with opportunities and skills that they can enjoy for many years. Parents need to be educated regarding the health benefits of regular physical activity and its contribution to the quality of life and given the skills to incorporate activity into their daily lives involving the entire family. As our society continues to perform less occupational physical activity, the population will require new ways to obtain adequate and regular physical activity to promote a healthy life. | ||||||||||||||||||||||||||||||||||||||
| REFERENCES |
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Available Volumes
| EDITOR IN CHIEF |
| Dr.
Rajeev Gupta (MD PhD FACC) |
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| HON. EDITOR |
| Dr.
Soneil Guptha (MD FACC FESC) |
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