13 October 2010

Regular physical activity enhances health and reduces the risk of various chronic diseases.

A sedentary lifestyle is a cause of weight gain, overweight and obesity. Overweight and obesity, in turn, are causes of chronic diseases such as diabetes, heart disease and cancers.

Another important cause of weight gain, overweight and obesity is unhealthy eating habits. These chronic diseases are therefore caused by unhealthy eating pattern and sedentary lifestyles. Prevention of these diseases must therefore be targeted towards these two main causes.

The Malaysian Dietary Guidelines (MDG) 2010 aims at promoting appropriate dietary patterns and active living. I have summarised the 14 key messages contained in the MDG 2010 and delved in detail two of the key messages in previous write ups.

This write up focuses on the third key message of the MDG 2010: be physically active every day.

Preventing chronic diseases

Researchers have long concluded that increased physical activity helps to lower the risk of various chronic diseases. A large amount of research data are now available confirming the benefits of regular physical activity for cardiovascular disease, diabetes and various types of cancers.

International health agencies such as the World Health Organization, the World Cancer Research Fund and the International Diabetes Federation have acknowledged that there is convincing evidence that regular physical activity prevents the development of these chronic diseases. These authorities have been advocating the need for increased physical activity in the prevention and management of these diseases.

In addition, many studies show positive effects of either a physically active lifestyle or exercise interventions on bone, joint and muscle health and performance. Several studies have also indicated that physical activity improves mood and reduces symptoms of depression and anxiety.

These chronic diseases, particularly heart disease and cancers, have become major causes of death in this country for over 30 years. Most of us would know of family members or relatives or friends suffering from one or more of these diseases. The suffering is immense, and the cost of treatment expensive. Prevention of these diseases must be the only option. That would mean adopting healthy eating habits and an active lifestyle.

Current status

The nationwide 3rd National Health and Morbidity Survey (2006) found that almost half of Malaysian adults were leading a sedentary lifestyle. More women than men were found to be inactive. It was also found that more urban adults were sedentary compared to rural folk.

This lack of physical activity amongst Malaysians must be one of the reasons for the high prevalence of overweight and obesity we see in this country. It must be one of the causes for the high prevalence of heart disease, diabetes and cancers too.

It is amply clear that there is an urgent need to tackle the low levels of physical activity among Malaysians. The Malaysian Dietary Guidelines 2010 has therefore included a specific chapter to provide guidance on this. It is hoped that this message will be able to help to encourage and promote increased physical activity amongst all Malaysians.

Besides key recommendations and tips on how to achieve (summarised below) this, the MDG 2010 also provides a physical activity pyramid as a simple and useful guide on how to be physically active everyday. Activities listed at the base of the pyramid are activities that should be incorporated in daily life and what an individual should do most often.

Activities listed at the top of the pyramid are activities that are sedentary and an individual should limit these activities during waking hours. The recommendations for physical activities summarised in the following paragraphs are based on this physical activity pyramid.

MDG Key Message 3: Be physically active every day

There are four key recommendations within this key message. Within each of the following key recommendations, the MDG has provided several tips on how to achieve these recommendations.

1. Be active everyday in as many ways all you can.

a. Always attempt to incorporate more physical activities in daily life as a form of exercise. Think of each movement as an opportunity for improving health, rather than as an inconvenience.

b. Do these activities whenever possible so as to be more active:

·Choose to walk up the stairs, instead of taking the lift or escalator.

·Choose to walk to the shop, surau or other places of worship, instead of driving.

·Do housework manually, such as sweeping and mopping the floor and hand washing clothes, instead of using automated machines.

·Park cars a distance away and walk to intended destination.

·Take up gardening, such as moving pots or trimming plants.

2. Accumulate at least 30 minutes of moderate intensity physical activity on at least five to six days a week, preferably daily. When fitness improves, the intensity level of physical activity and the amount of time spent on physical activity can be gradually increased.

a. Start off by doing moderate intensity physical activities, such as playing badminton, brisk walking, aerobic exercise, sepak takraw, cycling (medium-paced), swimming (medium-paced) or indoor activities in a gymnasium.

b. Remember moderate intensity activities, such as brisk walking, can be incorporated into daily life (such as walking 10 minutes on the way to work, and 10 minutes on the way home, and using stairs whenever possible instead of the lift or escalator).

c. As fitness improves, aim for 60 minutes or more of moderate intensity activities, or 30 minutes or more of vigorous physical activity that makes you “huff and puff” such as brisk walking (faster pace), jogging, playing football, squash, tennis, netball and basketball every day.

3. Participate in activities that increase flexibility, strength and endurance of the muscles, as frequently as two to three times a week.

a. For flexibility activities, all major muscle groups such as legs, hips, back, chest, abdomen, shoulders, and arms should be exercised. Flexibility exercise should be performed in at least four repetitions for each muscle group. Flexibility exercises include stretching exercises, yoga and tai chi.

b. Resistance and strength training exercises should be performed in sets of eight to 12 repetitions of eight to 10 different types of exercises that condition the major muscle groups. As muscle strength improves, the number of sets performed can also be increased accordingly. Strength exercises include push-up, weight training (dumb bells) and boxing.

c. Endurance activities are characterised by high intensity and long duration. These activities should be spread out across the week in order to avoid excessive fatigue and to reduce the risk of injury. Endurance physical activities include running, marathon and distance bicycling.

4. Limit physical inactivity and sedentary habits

a. Limit sedentary activities to a maximum of two hours or less in a day. For example, watching television, playing video games, surfing the internet and sitting or lying down (except when sleeping).

b. Always attempt to perform some simple activities such as stretching or sit-ups during intervals of watching television or working at the computer.

Note for overweight or obese persons: To lose weight, a total of more than 30 minutes a day of moderate-intensity physical activity is recommended, whilst approximately 45 to 60 minutes per day of moderate intensity physical activity is required to prevent the transition from overweight to obesity.

For weight control and for preventing weight gain or regain among formerly obese individuals, a total of 60 to 90 minutes a day of moderate intensity activity or lesser amounts of vigorous activity is recommended.

Be up and about!

Do not doubt anymore. Lack of physical activity is a cause of overweight and obesity. It is a cause of ill health and many chronic diseases, including diabetes, heart disease and cancers. Regular physical activity (combined with health eating) is protective against excessive weight gain. It also protects against chronic diseases.

All family members must be physically active. Children must develop a habit of being physically active from a young age. They must reduce time spent on television watching, reading, doing computer work.

Let the MDG 2010 guide you and your family members in adopting healthy eating habits and an active lifestyle. The complete MDG is obtainable from the Ministry of Health website: www.moh.gov.my/v/diet. The Nutrition Society of Malaysia has also made available leaflets of these MDG suitable for the public (www.nutriweb.org.my).

NutriScene is a fortnightly column by Dr Tee E Siong, who pens his thoughts as a nutritionist with over 30 years of experience in the research and public health arena. For further information, e-mailstarhealth@thestar.com.my.

This article was published in www.thestar.com.my on 26 September 2010.