Sunday,  December 3, 2000		Keeping fit

IT has been said that the battle of Waterloo was won in the playgrounds of Eaton and Harrow. Even for the battle for a happy and adjusted life good nutrition, physical fitness and balanced emotional life are the key ingredients. An active physical life can go a long way to help attain this goal. As a reaction to the hunting/stone age or even the agriculture age, man has always tried to find a way to relieve his calf muscles and avoid physical drudgeries. He used the horse, invented wheel, steam engine and all the modern physical contraptions to avoid physical labour. As a result the pendulum shifted to the opposite and it became possible for the urbanised man to completely do without any physical effort.

According to the Textbook of Harrison, only 22 per cent of American adults engage in light to moderate physical activities and almost 25 per cent of them pursue no such activity. If that be the state of affairs in an apparent physically active nation, it is anybody’s guess as to what may be happening in our own country.

A look at the playgrounds of the educational institutes, including the Panjab University, and other sport activities in Chandigarh itself, does not make for a very encouraging observation. We have recently celebrated the achievement of a lone bronze medal won by a lady in the Olympics Games at Sydney. We need to develop the awareness for this physical culture like the developing countries. The Royal College of Physicians of Britain, the American College of Sports Medicine and the Centre for Disease Control have published long guidelines for physical activities for the citizens and emphasised its benefits.

We should shake off ourselves specially our children from the cable TV culture and what my respected teacher late P.N. Chhuttani used to call charpai-rajai (quilt) culture.

Exercise has far-reaching consequences on the human body. Without any investment on any equipment or costly gyms, full benefit can be attained by anybody interested in it. Physical exercise activates the sympathetic nervous system and thus puts the whole body on the alert, increases muscle activities which is very obvious, increases the cardiac activity and cardiac output, increases oxygen supply and there are physiological adaptations which make more oxygen available to the muscles and also greater extraction of oxygen at the peripheral level.

It increases the size of muscle fibres, increases bone calcium, increases gastrointestinal tone, burns carbohydrates (sugar) and lowers the blood cholesterol at the same time increasing the HDL cholesterol which is cardio-protective. Blood pressure increases during the exercise but in the long run it decreases the blood pressure. Now it is recognised that that wonderful feeling of wellbeing after a game or a relaxing exercise is due to production of endorphines by the brain which are nature’s own opiates.

Exercise benefits virtually every system and cell of the body. It decreases blood pressure and can normalise blood pressure in the mild hypertension, improves the cardiac function, produces electric stability of the heart muscles and thus reduces the risk of cardiac arrthymia and, possibly, sudden death. It indirectly benefits the cardiovascular system by weight reduction and better control of diabetes mellitus. It improves the skeletal muscles and joint muscles by increasing the physical capability, ameliorating effect of chronic age and disease, reducing risk of injury, strengthening the tendons and tissue around the joints, lubricating the joint cartilages and capsules, and maintenance of flexibility. It helps in maintenance of the bone mass and calcium deposits in the bones and particularly in the later age and post-menopausal women.

Exercise enhances metabolic functions by controlling the body weight and preventing obesity. It increases insulin sensitivity and thus ameliorates diabetes mellitus and lowers cholesterol which is a major risk factor in the coronary heart disease. It inhibits the blood clotting process and stickiness of the blood and thus further contributes to the reduction in the heart attacks.

The recently published follow-up of famous Harvard Alumini in relation to stroke shows enormous benefits of physical activity. In the study they have observed and analysed over a long time the health of 11130 men who matriculated at the Harvard University between 1916-1950. The study shows clear benefits of increasing physical exercise over the years and reducing the risk of stroke as well as heart diseases with the physical exercise. The physical exercise has very positive influence on the psychological functioning as well. It reduces anxiety and depression and thus elevates the mood, enhances the psychomotor development and capability to face impediments. It improves memory and above all increases self-esteem and thus ameliorates stress related conditions.

Benefits of physical exercise do not stop at any age, even if the person was not physically active earlier. Benefit of physical exercise in the elderly people is enormous because it increases their musculo-skeletal functions and decreases osteoporosis. The cardiovascular system is stabilised and muscle stability and nutrition is maintained. Even physically active wheelchaired users have less morbidity than the inactive ones.

Exercise and physiotherapy plays a very important role in disease as well. It is the key to recovery and rehabilitation in all orthopaedic, neurosurgical and rheumatological diseases. Surgeons insist that the patients walk the very next morning of the surgery. Even after an acute heart attack, unless there is a complication, patient is encouraged to start walking within eight hours. Gone are the days when a patient was made to lie like a log of wood for six weeks after a heart attack.

There are many recommendations available. The first principle is to get a good medical evaluation if somebody is starting the physical programme for the first time so that a pre-existing disease of some kind may be detected and taken care of. It has been advised that a 40 minutes to 1 hour of quick walking most days of the week (or at least three days a week) is adequate. The above quoted study of the Harvard Alumini found that a person walking more than 20 km per week, or climbing more than 24 flights of stairs per week had significantly less strokes.

A recent study also shows that if physical activity cannot be sustained for 40 minutes, even effort of 10 to 15 minutes physical activities is beneficial. In other words, any physical activity is better than no activity. There are just no requirements and no barriers for physical activities.

Just start walking, go to the lake, go to the leisure valley, walk to your workplace, keep your car away from the office and walk, do not take the lift. Of course if you can play a game join a gym or a golf club (if you are status-conscious) nothing like it. A lot of information is available on how to organise an exercise programme.

One should start with stretching or warming up, carry on the main exercise and then de-accelerate slowly so that the cardiovascular system, muscles and joints are accelerated and de-accelerated in a graduated fashion. This prevents injuries to the joints and muscles and cardiovascular collapse which can occur by abrupt stopping of a severe about of exercise.

The question that is physical exercise harmful has been asked many times. Yes, it can be if done in an unplanned fashion and if an uninitiated person suddenly starts an unaccustomed exercise. Precipitation of angina, heart attack and even sudden death have been recorded when sedentary people suddenly start a rather vigorous exercise. It is usually because of undetected underlined heart disease or occurrence of arrthymias due to liberation of sympathetic system hormone or dropping of potassium level in the blood. A middle aged, Chandigarh resident suddenly thought of reducing his weight and walked upto Kasuali one morning. He reached the top but survived the heart attack because of help he got from the Army Hospital there . This information is not being given to discourage exercise. The best way to prevent these complications is to exercise all the time. The risk is too small as compared to the benefits.

A word about jogging. In the last few years jogging became a popular form of exercise. There is nothing against it provided it is done with proper shoes, clothing and on a suitable surface. Jogging or skipping on a hard surface can virtually injure every joint of the body. That is a hazard of any vigorous exercise or game. Active runners and athletes do end up with joint or bone injuries. Maybe it is worth it.