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The best kind of preventive medicine is exercise. Kasmiah Mustapha talks to an expert in physical medicine
EXERCISE? How many of us come up with all sorts of excuses to opt out of physical exercise because it is too much of a bother?
We know exercise will help in achieving weight loss but we may not realise that it is also the answer to reducing the risk of chronic diseases. Exercise was proven as an effective method to stay healthy even back in the 5th Century BC.
Greek physician Hippocrates said: “Eating alone will not keep a man well; he must also take exercise. For food and exercise work together to produce health.”
In 600 BC, Indian physician Sushruta found that exercise had reduced the level of blood sugar in diabetic patients.
In modern medicine, numerous studies have revealed that there is a link between exercising and health. Regular exercise has been proven to reduce the risks of diabetes, hypertension, cancer (particularly breast and colon), depression, osteoporosis and dementia. Studies have also found there is a correlation between exercise and prevention of premature death.
Consultant in physical medicine and rehabilitation at Sime Darby Medical Centre Ara Damansara, Dr Tunku Nor Taayah Tunku Zubir, says that despite the proven scientific studies on the benefits of exercise, many Malaysians tend to exercise only when they have already suffered a stroke or heart attack.
The 1996 Malaysian National Survey found that 31 per cent of Malaysians above the age of 18 had never exercised. Of that figure, less than 12 per cent exercise adequately. The figure remains the same almost 14 years later in a similar study. The 2010 figure revealed that less than 30 per cent of Malaysians exercise and out of that, only 17 per cent are doing it right.
“This figure is worrying, “says Dr Tunku Nor Taayah. “Malaysians, regardless of age, must include exercise as part of their daily routine like brushing teeth and taking a shower. The idea that exercise is a hobby or something we do when we have time is wrong. They should make the effort to exercise and stop making excuses.
“Sadly, they only exercise when they are forced to do it, such as after a stroke or an accident. Then, they follow doctor’s advice and exercise regularly.
“But once they are no longer in pain, they will stop exercising. The argument is that since they are not sick, why should they bother? They may not realise that even if they are not sick now, with their unhealthy lifestyle, they are at risk of being sick sooner or later.”
Dr Tunku Nor Taayah says the lack of prevention methods through a changed lifestyle has caused the rate of chronic diseases to increase over the years.
In the Malaysian Third National Health and Morbidity Survey 2006, 70 per cent of Malaysian adults suffer from non-communicable diseases such as diabetes, hypertension and cancer and they account for 71 per cent deaths in the country.
Risk factor prevalence in Malaysia, especially physical inactivity— at 15 per cent — is the highest among Southeast Asian countries. It is revealed that at least 80 per cent of premature heart disease, stroke and type 2 diabetes and 40 per cent of cancers could be prevented through regular exercise and a healthy diet.
REDUCING FINANCIAL BURDEN
Exercise will also reduce the economic burden on the treatment of patients with chronic diseases. Studies done in Kelantan found the cost for treating patients with type 2 diabetes at medical wards was at RM2,161 per patient per admission.
Dr Tunku Nor Taayah says to ensure the benefits of exercising, people need to follow the right exercise regime using the FITT rule: Frequency, Intensity, Time and Type. People should also be aware of the difference between physical activity and exercise.
Physical activity means any body movement that involves the skeletal muscles such as walking. Exercise is a subset of physical activities that is planned, structured, repetitive and purposeful for which improvement or maintenance of physical fitness is the aim.
“Physical activity alone is not good enough. You need to get involved in movement that will increase heart rate and have your blood flow strongly in your body, which in turn, will make all your organs healthy.”
She says exercise should include
• Aerobic fitness, which will reveal the body’s ability to take in and use oxygen to produce energy
• Muscular strength, the amount of force a muscle or group can exert against a heavy resistance
• Muscular endurance, the ability of a muscle or muscle group to repeat a movement many times or hold a particular position for an extended period of time, and
• Flexibility, the ability to bend joints and stretch muscles through a full range of motion.
If a person is at a pre-stage of a chronic disease, the doctors may not put him on medication immediately. Instead he is advised to change his diet and exercise. If he follows the right steps, he will be able to reduce his risk without medication.
“But if he is already diagnosed with a chronic disease, he will need to be on medication. In this case, his treatment includes medication, diet and exercise. His risks of other complications can be reduced if he follows a healthy lifestyle.”
Dr Tunku Nor Taayah, whose patients are stroke survivors, those who are obese and those suffering from knee pain and injury, says doctors are now more aware of the need to prescribe exercise.
“It is not enough to tell patients to exercise, doctors need to monitor their progress. If patients are uncomfortable exercising in public, they can climb stairs or do brisk walking around their house or even gardening. Doctors also need to look at their medical history, physical condition and fitness level and then advise them based on the information.”
THE EXERCISE pill
ACCORDING to the Surgeon General’s Report on Exercise and Physical Activity 1996 (US), exercise
• Reduces the risk of dying prematurely from heart disease
• Reduces the risk of developing diabetes
• Reduces the risk of developing high blood pressure
• Reduces blood pressure in people who already have high blood pressure
• Reduces the risk of developing colon and breast cancers
• Helps to maintain a healthy weight
• Helps build healthy bones, muscles and joints
• Helps older adults to become stronger and better able to move about without falling
• Reduces feelings of depression and anxiety
• Promotes psychological well-being