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DAILY STEPS FOR GOOD HEALTH

There is absolutely gold-standard evidence that physical activity can reduce morbidity and mortality due to multiple chronic conditions. The mountain of evidence can be gauged from the fact that there are 948 meta-analyses of 11,726 clinical trials, in addition to 1.4 million research papers, that leave no doubt about the unquestionable necessity of physical activity for good health. Drawing on the leading research, here we discuss the most popular and easier form of exercise, walking, to assemble usable knowledge. For significant health benefits, World Health Organization (WHO) suggests, adults should do at least 150 to 300 minutes of moderate-intensity aerobic physical activity; at least 75 to 150 minutes of vigorous-intensity aerobic physical activity; or an equivalent combination of moderateand vigorous-intensity activity distributed throughout the week. On average, leisure-time regular physical activity should be within about 45 minutes a day.

Exercise can protect against metabolic syndrome, hypertension, cardiovascular disease (CVD), type 2 diabetes, dementia, Alzheimer’s disease, cognitive decline, migraine, autoimmune diseases, and at least 26 types of cancers, among others. Exercise also lengthens telomeres, reduces stress, and attenuates cellular ageing. It also promotes bone health. It prevents frailty and age-related pathogenesis including macular degeneration. In addition to protecting against non-communicable diseases, physical activity can help us fight communicable diseases, such as COVID-19, through enhanced immunity. Higher, but not excessive, levels of physical activity increase the odds of healthy ageing by 39 per cent. Overall, physical activity contributes to healthy longevity and promotes happiness, healthspan and well-being.

Physical activity is so vital, the world must be craving to do that every day. Right? Well, not really. People have their own reasons for being lethargic. A study published in the Lancet Global Health on the worldwide trends in insufficient physical activity found evidence otherwise. The global prevalence of insufficient physical activity was 27·5 per cent. This puts more than 1·4 billion adults at risk of developing or exacerbating diseases linked to inactivity. India has its own lazy stars renowned for slothfulness. About 34 per cent of adult Indians are insufficiently active. Half of Indian children and adolescents do not meet the required levels of physical activity of 60 minutes per day. This is giving rise to the occurrence of more than 3 disease conditions in the same person, often known as multimorbidity. The highest proportion of adults from northern India, i.e., 49.6%, have low levels of physical activity.

Young people aged 10–24 years constitute 24 per cent of the world’s population, and more than 80 per cent of them have insufficient physical activity. Approximately 30% of people aged more than 60 years experience a fall in a given year. Physical activity in such people can enhance resilience, robustness and fitness. This inaction costs hugely. Physical inactivity cost healthcare systems 53·8 billion dollars worldwide. It is also responsible for 13·4 million disability-adjusted life-years worldwide. CVD, respiratory diseases and diabetes kill more than 4 million Indians annually, and most of these deaths are premature, occurring among Indians aged 30–70 years.

The time has come to move and keep moving every day. One of the easiest and most popular physical activities, recommended by ancient India’s Sage-Scientist Acharya Sushruta, 5000 years ago in Ayurveda, is walking. Sage-Scientist Acharya Charaka says that physical activity is the best among all the factors that confer physical and mental resilience. Charaka and Sushruta prescribed exercise for health at least 1000 years before Hippocrates (460–370 B.C.) and Galen (129–210 A.D.).

World’s oldest definition and prescription of exercise as medicine are found in Caraka Samhita, which was redacted from the world’s oldest record of medical practice. In this context, the number of steps taken per day is a simple measure of physical activity.

Monitoring daily steps with the help of trackers and wearable mobile devices have become increasingly fashionable worldwide. Cycling, swimming, and many other forms require special arrangements. But walking can be performed in any place. Green spaces and safe urban forests are great environments to walk. Forest experience, green exercise, gardening, and nature viewing all have positive health impacts.

The question is, walking is the most convenient exercise for healthy persons, how many steps need to be taken per day? A commonly promoted goal is 10,000 steps per day, its origin is anecdotal. This number became popular from a marketing campaign in Japan. The WHO 2020 Physical Activity Guidelines specifically identified this gap in research on the dose–response connection between volume (steps per day) and intensity (steps per min) of physical activity and consequent health outcomes. Here, we provide new evidence about various facets of walking for good health. The most important guidance has now become available through two outstanding meta-analyses.

The first on relates to daily steps and a l l - c a u s e mortality. It is based on a meta-analysis of 15 international cohorts with 47,471 adults. It suggests progressively decreasing the risk of mortality among adults aged 60 years and older with an increasing number of steps per day until 6,000–8,000 steps per day. For adults younger than 60 years, the step count is 8,000– 10,000 steps per day. The second study found an answer to the associations of daily step counts with cancer and cardiovascular disease incidence and mortality as well as all-cause mortality. It also explored if the intensity of steps has additional benefits. This population-based prospective cohort study used the data for 78,500 individuals of average 61 years of age. This study found that more steps per day, up to about 10,000 steps, was associated with a decline in mortality risks and decreased cancer and CVD incidence. These findings indicate that accumulating more steps per day, up to about 10 000, is useful to lower the risk of all-cause, cancer, and CVD mortality as well as the incidence of cancer and CVD. Higher step intensity or brisk walking may provide additional benefits, but it must not be taken too extreme.

What if you do not have time for taking 8,000 to 10,000 steps per day? Well, then the main thing is exercise and it does not have to be 10,000 steps. Do as possible. If you are able to do 3 to 5 length-standardized vigorous physical activity bouts every day, lasting about 2 minutes each, it can bring about a 40% reduction in all-cause and cancer mortality risk and about a 50% reduction in CVD mortality risk. These results indicate that small amounts of vigorous physical activity can substantially lower the mortality risks. In brief, the evidence has strengthened the conclusions drawn in Ayurveda, 5,000 years ago, including by Acharya Sushruta that moderate—but not excessive— walking enhances life span, strength, intelligence, digestive power, and invigorates all our sense organs.

Also, remember that sedentary time is independently associated with deleterious health outcomes regardless of physical activity. So, do not keep sitting for a duration longer than 40 to 50 minutes.

Interrupting prolonged sitting with short bouts of walking—but not merely standing—provides clinically meaningful improvements in metabolic health. Take a break, walk a few brisk steps, stretch, do some deep breathing, mindfully observe trees and green space from your window, and go back refreshed to work.

We have not discussed running here. There is compelling evidence that running provides significant health benefits for the prevention of chronic diseases and premature mortality. Running, regardless of its dose, is likely to lead to considerable improvements in health and longevity. And, any amount of running, even just once a week, is better than no running. But higher doses of running may not necessarily lead to greater benefits. Yet, it is not the best exercise for everyone because various clinical conditions and old age can impede its practice.

Finally, please remember that with all the goodness of a reasonable amount of physical activity, excessive exercise is a serious risk to health. Both Ayurveda and modern science warn against excessive physical activity. Vyayama (exercise) is a must for good health but must not be done beyond balardha (i.e., beyond half of your strength). Sweating, increased respiration, feeling the lightness of the body and tightness in the cardiac region are signs of optimal physical activity. The extent of physical exercise is governed by an individual’s capability. We should stop exercising before getting tired and should abstain from overexertion. Notwithstanding a cautionary note here, know that the benefits of physical activity outweigh the risks. Move and keep moving. Stay healthy, stay happy.

DR DEEP NARAYAN PANDEY Principal Chief Conservator of Forests (Head of Forest Force), Rajasthan

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