Health alert! Indians need to exercise more

A study published in The Lancet recently concluded that the prevalence of insufficient physical activity (PA) among adults has been increasing globally since 2000. The report says it has increased from an estimated 23.4% in 2000 to 31.3% in 2022. Of concern to readers here is that it has increased from 22.3% to 49.4% in the same period for India. It is important to note that insufficient PA means less than 150 minutes of moderate or vigorous physical activity in a week. For PA to protect the heart, it must make the heart work more than usual, indicated by an increase in heart rate or breathing harder, and must be done for at least 10 minutes at a stretch. PA has been shown to prevent many cardiometabolic diseases as well as cancers. And no, yoga is not counted as PA.

The key data sources are large population-based studies funded by the ministry of health and family welfare that use standard global tools and protocols. Having been personally involved in many of these surveys, I can vouch that measuring PA at the population level is incredibly difficult. We ask a series of questions about time spent usually or in the last week in moderate and vigorous activity at work (at home for the non-working), travel, and leisure time, or discretionary (self-driven). Assessing the intensity of the activity as moderate/vigorous and the time spent can be quite challenging. The activity per se is not enough. For example, one could swim or play badminton vigorously (competitive) or moderately or even with very little activity (float/laze in water). Similarly, walking could be brisk (about 5 km per hour) or slower or faster. People often overestimate both the intensity and the time taken for such activities. The use of wearable devices to measure PA is rising for such surveys, though this still has several operational challenges.

Acknowledging the difficulty in measurement does not subtract from the key finding that PA is declining in India. In general, our studies show that the rural population has higher PA, men are more active than women, older people have lower PA and most of our PA occurs in the work domain, especially in rural areas, and is much lower during leisure time or in the discretionary domain. In other words, we do not make efforts to do PA but do it only if it becomes necessary.

Is brisk walking (or similar PA) for 30 minutes daily difficult for most Indians? Women often do low-intensity housework for long periods and get tired without necessarily doing any cardio-protective PA. They seem unable to fit these 30 minutes into their daily schedule or consider this unnecessary. People do not even walk to the bus or metro station and use two-/three-wheelers instead. Inclement weather conditions and pollution further compound the problem. Most of us do desk jobs with little scope for any PA at the workplace. Long commutes leave us with little time and energy to do PA, even if one is interested. Rising screen times at all ages also hinder PA.

India is in transition as far as PA is concerned. As a chunk of the population ages and with rapid urbanisation, we are moving from work-based to discretionary as our predominant domain of PA. We need to create systems to facilitate it. The way out for women would be the partial automation of many chores; the saved time can be used for discretionary PA. As rural people move away from agriculture to factories and service industries, work-based PA will come down. With an increase in the purchase of motorised vehicles (explosion in the two-wheeler segment and budget cars), commutation-related PA is also coming down. Increased PA in the discretionary domain will have to compensate for these declines. The challenge is to make this transition smooth by making PA a habit.

People of all ages and genders exercising in parks in the morning and evenings are a common sight in the bigger cities. Public gyms have also made this more attractive. This shows that given the right nudge, people take up PA when an appropriate environment is created. Only education and fitness events will not cut it. Though they serve a certain group, more indoor gyms are also not a solution. We need to make our lives more physically active. For example, to promote cycle use, make it a safer and easier option. Promote stairs over lifts by making stairs easy to find in buildings and hotels. Build these habits at schools and promote PA in the workplace. We need more neighbourhood parks and spaces for children to play safely. While bigger and planned cities make provisions for parks, these are often missing in the unplanned growth of our peri-urban and suburban spaces. Our pavements are so haphazardly made that it is difficult to walk on them, even for the most agile. Why do our smart cities not promote health and PA as a core focus? Promoting PA has to become a central tenet of urban planning and design.

Finally, while it is good to see two large surveys funded by the health ministry contributing data for this estimate, these information sources are old (2017-18), and we need to have the next round of surveys to get a more updated picture and to do this regularly, the Union, state, and local governments need to promote PA at the population level; a goal of achieving a 10% reduction in insufficient PA by 2025 has already been set for the country. However, at the individual level, nothing stops one from taking the first step. It is, after all, for one’s own benefit.

Anand Krishnan is professor, Centre for Community Medicine at the All India Institute of Medical Sciences, New Delhi. The views expressed are personal