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Fit to be alive
The timing could not have been better. With the world's greatest sporting spectacle, the Olympics, just a couple of weeks away, the clamour to declare exercise as the fifth 'vital sign' has reached a high pitch. The existing four primary vital signs are temperature, pulse, blood pressure and respiratory rate.
An international team of researchers who set out to examine whether sport and exercise contribute to the health of nations now says that regular participation in such physical activities has clear benefits for the health of both the body and mind. Health professionals, therefore, need to pay more attention to their patients' fitness, they say.
"A low level of fitness is a better predictor of mortality than obesity or hypertension, which are health risk factors afforded far greater emphasis than fitness, " says Professor Karim Khan of the University of British Columbia, Canada. The researchers, therefore, suggest that if health professionals were to consider exercise levels as a vital sign, they could provide crucial help to patients by advising them suitable exercise regimes. This, they say, could result in dramatic improvements in the number of people who regularly exercise. "Clinicians can influence a large number of patients through brief interventions that promote physical activity and encouragement towards participation in sport for physically inactive patients. This qualifies as evidence based therapy. Exercise might also be considered as a fifth vital sign and should be recorded in patients' electronic medical records and routine histories, " says Khan's team.
The suggestion is of great importance to urban Indians who have some serious lifestyle issues. According to data provided by the union health ministry, around 79 of per cent men in India and 83 per cent of women are physically inactive, while 51 per cent of men and 48 per cent of women have high fat diets. Almost three in five men and an equal number of women have low intake of fruit and vegetables, while 12 per cent of men and 0. 5 per cent of women smoke. Around 41 per cent of men and 45 per cent of women are overweight and suffer from obesity, while 30 per cent of men and women have high blood pressure. High cholesterol affects one-quarter of all men and women, and diabetes was reported in 34 per cent of men and 37 per cent of women.
The recent Indian Heart Watch (IHW) study - the largest-ever heart risk factor study in India that took place over a five-year period (2006-2010 ) and involved 6, 000 men and women from 11 cities across various regions - found that approximately one-third of study participants suffered from hypertension. The Indian Council for Medical Research (ICMR) says work-related sedentary lifestyle is high in urban (64. 1 per cent) and semi-urban areas (44. 8 per cent) as compared to rural areas where the figure stands at 39 per cent. Projection studies show that prevalence of overweight individuals is expected to rise from 12. 9 per cent (13. 48 cr) in 2005 to 27. 8 per cent (29. 07 cr) by the year 2030. Similarly, obesity figures will rise from 4 per cent (4. 22 cr) in 2005 to 5 per cent (5. 21 cr) by 2030.
The Planning Commission says a quarter of men (24 per cent) and onethird of women (34 per cent) of women report inadequate physical activity (defined as 1-149 minutes of activity in seven days). The proportion with inadequate physical activity is 39 per cent and 27 per cent in urban and rural areas, respectively. The high income group is by and large more physically inactive (28. 6 per cent vs 24. 7 per cent) as compared to the low-income group.
According to Khan who published his study in the Lancet on Friday, "the evidence for physical activity as a major public health preventive approach and a potent medical therapy has increased exponentially in the 64 years since London last hosted the Olympic Games. We believe that small changes at the community level and large, nationwide policies and initiatives are needed to improve health at a country level. "
Despite the lack of high-quality data on nationwide sport participation levels, existing studies appear to show clear health benefits associated with regular participation in sport and/or exercise.
For instance, a series of randomised trials published in 2010 showed that people who started playing football two or three times a week, having formerly never played the game, experienced reduced risk factors for cardiovascular disease, diabetes and osteoporosis.
Large cohort studies suggest that such participation in sport is associated with a 20-40 per cent reduction in all-cause mortality compared with non-participation.
"When big sports events take place, like the Olympic Games or the FIFA football world cup, they promote public health. Such events can inspire onlookers to be physically active and thus obtain health benefits. Physical activity, exercise and sport contribute to health in part through their effect on cardio respiratory fitness, " says cardiac surgeon Dr Ramakant Panda.
The American College of Sports Medicine's 'Exercise Is Medicine' programme argues for a "merging of the fitness industry with the health-care industry, so that patients can be better helped to find an appropriate fitness regimen". "Patients ought to report how many minutes of physical activity they undertake in an average day and how many days a week such activity takes place. This measurement provides a score that can alert patients and clinicians to potential risks related to inactivity, " the Lancet said.
"All clinicians, including nurses, physiotherapists and dieticians, can encourage this commitment. Clinical exercise physiologists and physiotherapists have a specialised role in supporting patients to launch their preventive or therapeutic physical activity programmes, " the experts added.
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