People are not active enough worldwide, and Indians even less so. Less than 10 per cent adults in India meet the World Health Organisation-recommended 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 women are far less active than men. Only three per cent women meet the minimum healthy levels of physical activity, which brings a clutch of health benefits such as reductions in the risk of hypertension, coronary heart disease, stroke, diabetes, breast and colon cancer, obesity, depression, risk of falls, and improvements in bone and functional health.
Lead author 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 cyclothans. And the health benefits are showing. Our 2017 study from 15 states found diabetes and pre-diabetes in urban India is 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,” said Anjana.
“Globally, 27·5 per cent people are “insufficiently physically active” and not meeting the WHO norms, with women being less active than men, showed data from 168 countries that included 1·9 million people, published in The Lancet in 2018.
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 and the leading cause for 21–25 per cent of breast and colon cancers, 27 per cent of diabetes, and 30 per cent cardiovascular disease.
“It is a huge public health lever that is not being tapped. It’s scientifically established that regular and sufficient physical activity improves muscular and cardiorespiratory fitness, improves bone and functional health, reduces risk of hypertension, coronary heart disease, stroke, diabetes, various types of cancer, and depression; reduces the risk of falls and hip or vertebral fractures; and improves weight control,” said Shifalika Goenka, professor at Indian Institute of Public Health.
Asking people to be more physically active is not enough. The 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.
Lower- and middle-income countries like India also face environmental and social challenges that become deterrents to activity, such as rapid urbanisation that leads to unplanned growth of cities, high migration, large populations, chaotic transportation, encroached pavements, air pollution, and high ambient temperature, which causes heat exhaustion.
“Trees and green spaces within a 0.5 kilometre radius of homes, workplaces, and schools have been shown to bring many health benefits, such as lowering 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, lower air pollution to making walking, cycling and other outdoor activities more comfortable, she said.
“Instead of widening roads for motorised transport, 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, active living is essential to improve population health,” said Goenka.
“The excuses are the same across states. We have no time, it takes away my time from family, I have no money for the gym, the clothes are inappropriate, etc. 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 Anjana.
Physical inactivity, which is defined as at least 30 minutes of sustained walking, hiking, dancing, running, swimming, or playing games or a sports, 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 Anjana.