A suitable prescription for an unfit nation

Dr Anoop Misra, Chairman of Fortis C-DOC Hospital 
(First published in the LiveMint News)
“Doctor, I cannot exercise because of cold/hot/rainy weather; dogs and mosquitoes/ chain snatchers/beggars on the street; parties, etc”—utterances that I hear from my patients ad nauseam. Very few state that the inability to do exercise is primarily because of their laziness. Many of them have a stationary exercise bicycle, treadmill, or even a fully equipped gym at home. Having worked in India, the UK and US, I firmly believe that urban Indians are far more inactive as compared with other races. Is it in our genes? Unlikely.

Is it a combination of lack of awareness, bent of mind, lack of opportunities (for example, open spaces), urban stress, and putting higher priorities for job, family and exams? Perhaps yes. Exercise remains the easiest, cheapest and most convenient lifesaver. Remarkably, daily exercise prevents more than 20 diseases including diabetes, heart disease and cancer, and in three out of 10 people, early death, and yet, derives so little attention from Indians! No wonder diabetes and heart disease is striking them in their 20s and 30s.

But not all of this is an individual’s fault—doctors should also be held accountable for this sorry state of affairs. Sometime back, the world’s premier medical journal The Lancet opined that exercise should be listed as an investigative question in every person’s medical record. Unfortunately, 90% of Indian physicians neither record it, nor give any instructions. There is a lot of advice regarding exercise given by word of mouth and plenty is available in the media and on the Internet; but sadly, most of the advice is wrong. Most importantly, few have taken body composition and metabolism of Indian bodies into account. In a published consensus statement, Indian experts opined that Indian bodies need more exercise (to counter high body fat, low muscle mass, and sluggish livers and multiple defects in metabolism that are typical of Indian bodies) than advised by international health associations.

So, is the 60 minutes daily regimen of exercise, as advised by Indian experts, practically feasible for a busy city-based executive, or for that matter, for the general public? Yes, it is. And all that one needs is just a pair of shoes and some space to exercise. You could even exercise on the spot (for example, skipping).

Make room for 30 minutes of leisure time aerobic physical activity (walking, treadmill walk, cycling, aerobic sports, aerobic dancing, skipping, swimming, etc.) per day, and this should be sacrosanct each day of the week. One could mix various exercises (for example, aerobic dance and walk) to fill up 30 minutes. And these 30 minutes could also be accumulated in installments (for example, 10 minutes each, three times a day), particularly for those who cannot walk for more than a few minutes at a time because of knee pain or some other musculoskeletal ailment. Another 15-20 minutes could be easily managed while at work. You could include 3-4 segments of 5 minutes each (total 15-20 minutes) during work-- pacing in the room, short walk before lunch, taking a walk while discussing work or even dictating your letter, walking to the Metro after hectic meetings, etc.

This leaves just another 10 minutes of exercise to be managed, to make it an hour of exercise daily. These 10 minutes should be devoted to exercises that increase the toning and functioning of muscles. Because of exposure to centuries of starvation and famine, our muscles are thin and low on blood flow and strength. Further, research from our group showed that the muscles of Indians are not all muscles, but have plenty of fat in-between muscle fibres (fatty muscles). These streaks of fat act as roadblocks for the working of the hormone insulin, and prevent it from reaching the cells effectively, thus jeopardizing the metabolism of glucose and cholesterol. Functionally, such weak muscles lead to poor physical performance-- a possible reason that India has rarely produced world-class athletes and sprinters. Medically, the glucose-cholesterol metabolism is disrupted majorly, leading to the rise of blood glucose, cholesterol, fat deposits in the liver and hardening of arteries.

Do you need to start lifting heavy weights and join a gym for this purpose? Do you need to build muscles like a bodybuilder? No, not at all. We want muscles to be optimally functional and physiologically efficient. To achieve these goals, you need to lift small weights (Velcro attachable on the wrist and legs are preferable). One could start under expert supervision to learn weight training (small weights of 1, 2, 3, 4, 5kg each), with 10 repetitions of weights, using major muscles of arms and legs in three directions for at least 10 minutes five-seven times per week (you can do on your own once you learn it properly). Start with smaller weights, keep going till the muscles are fatigued, then gradually increase repetitions and use increasingly bigger weights.

Will this regime solve fitness issues, and prevent diabetes and heart disease among Indians? Certainly, provided we are watching our diet carefully as well. This entire exercise regimen should be individualized according to the physical fitness and medical condition of the individual. For this a physician and exercise specialist must be consulted first. Any other form of exercise (for example, yoga) should be secondary to the stated exercise regimen.

For me, exercise is a lifeline, much more preferable to tablets, injections, angiographies, stents and walking with the help of a stick (in the event of stroke). Are we an unfit nation? Largely yes. Could we become a fitter nation? Surely yes, if all of us sweat it out daily.
(First published in the LiveMint News)

Dr Anoop Misra
16 February 2015  
(The author is chairman of Fortis C-DOC Hospital for Diabetes and Metabolic Diseases)