india

Updated: Aug 30, 2019 07:41 IST

People are not active enough worldwide, and Indians even less so. Fewer than 10% adults in India follow the World Health Organization (WHO)-recommended regimen of at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity through the week, according to an ongoing pan-India study across 25 states by the Madras Diabetes Research Foundation.

The study, which is part of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study and the most comprehensive analysis of physical activity patterns across states, has found that women are far less active than men. Only 3% women meet the minimum healthy levels of physical activity, which brings a clutch of health benefits such as the reduced risk of hypertension, coronary heart disease, stroke, diabetes, breast/colon cancer, obesity, depression and falls, as well as improvement in bone and functional health.

Lead author Dr Ranjit M Anjana, managing director, Dr Mohan’s Diabetes Specialities Centre, who also led the Phase 1 ICMR-INDIAB study conducted in four states in 2014, said higher awareness is increasing activity, but the change is not happening fast enough. “Over the past decade, there is a definite improvement in urban areas, where higher awareness is leading to more people walking, running and participating in walkathons, marathons. And the health benefits are showing. Our 2017 study from 15 states found diabetes and pre-diabetes in urban India are decreasing with increasing physical activity and healthier diets, but it is going up among the urban poor and the rural rich, who haven’t made the transition to a healthier lifestyle,” he said.

Global Pandemic

Globally, 27.5% people are “insufficiently physically active” and not meeting WHO norms, with women being less active than men, according to data from 168 countries, which included 1.9 million people, published in The Lancet in 2018.

People in Latin America and the Caribbean, South Asia, and high-income Western countries were the least active, while men from Oceania, east and South-east Asia, and sub-Saharan Africa were the most active. Physical inactivity was twice as high in high-income countries compared to low-income countries in 2016, the study found.

Physical inactivity damages health as much as obesity and smoking. It is the fourth-leading risk factor for death (6% of deaths globally) and the leading cause of 21-25% of breast and colon cancers, 27% of diabetes, and 30% of cardiovascular disease.

“It’s a huge public health lever that is not being tapped. It’s scientifically established that regular and sufficient physical activity improves muscular and cardio-respiratory fitness, improves bone and functional health, reduces risk of hypertension, coronary heart disease, stroke, diabetes, various types of cancer (including breast cancer and colon cancer), and depression; reduces the risk of falls and hip or vertebral fractures; and improves weight control,” said Shifalika Goenka, a professor at Indian Institute of Public Health who has authored commentaries on physical activity in India in The Lancet.

While evidence of the benefits of physical activity is growing, most countries have failed to scale up effective intervention at the population level.

Asking people to be more physically active is not enough. WHO’s Global Action Plan on Physical Activity launched last summer proposes solutions to strengthen leadership, governance, workforce capabilities, and advocacy to create a social movement to address the complex problem of physical inactivity. It’s essential to create a physical, social and political environment that makes physical activity desirable, accessible and safe, and this can be done with cross-sectoral collaboration between civic agencies, town planners, private companies, non-profits, clubs and the community, according to WHO.

Planned Action

Lower- and middle-income countries such as India also face environmental and social challenges that become deterrents to activity, such as rapid urbanisation, which leads to unplanned growth of cities, high migration, large populations, chaotic transportation, encroached pavements, air pollution, and high ambient temperature. “Trees and green spaces within a 0.5km radius of homes, workplaces, and schools have been shown to lower the risks of death, cardiovascular disease, prostate cancer and depression, and better cognitive development in children,” said Goenka.

Apart from adequate quality public transport and wider pavements, there is need for more tree cover on active transport roads, green spaces to lower the ambient air temperature and mitigate noise pollution, and lower air pollution to make outdoor activities more comfortable, she said.

“Instead of widening roads for motorised transport at the cost of trees, pavements and green spaces, governments should focus on pedestrians and other active transport priorities like public transport. A measure of development of a country is how well we treat pedestrians and those using active transport... It is rare to find an intervention that has such powerful and far-reaching benefits,” she said.

Progressive interventions, especially those targeting women, are needed to create a safe space for women. “The excuses are the same across states. We have no time...It’s a pity because exercise is a physical activity, is a positive change and easier to adopt than diet changes, which are all about not eating this or that,” said Dr Anjana. Physical activity, which is defined as at least 30 minutes of sustained walking, dancing, running, swimming, or playing a sport, can take any form. “It doesn’t matter what you do, adults have to be physically active for at least an hour every day and double that to lose weight. Unless you are active for 60 minutes over and above your daily routine, you cannot meet the target of 10,000 steps day,” said Dr Anjana.