Physical Activity and Exercise in Medicine. Your Exercise or Your Life?

Written by: Andri Dauni, Ying-Xian Goh, and Chin Siok Fong (Ph.D.)
Published date: 30 March 2021

Photo courtesy: everything bagel/ Shutterstock

People feel perplexed when they learn about the difference between physical activity and exercise. Physical activity is referring to any body movement such as walking, running, and sweeping. This movement is initiated by the contraction of the skeletal muscle either in a structured or unstructured way and will cause energy expenditure above the basal level. Based on daily life purposes, physical activities can be categorized into the sport, household, occupational, and conditioning activities. Meanwhile, exercise is a subset of physical activity that is planned, structured, repetitive, and purposely focused on the development, improvement, or maintenance of physical fitness and overall health such as running and weight lifting [1–3].

Historically, the contribution of exercise to health, especially in treating chronic conditions and diseases, is unquestionable. The medicinal qualities of physical activity/exercise are backed by overwhelming research since before the common era (BCE), pioneered by Hippocrates (460 – 370 B.C.) and Galen (129 – 210 A.D.). In this context, Hippocrates was the first doctor who prescribed exercise to his patient; while Galen stressed that both health and lifestyle are responsible for one’s well beings, popularizing the old adage “we die by the way we live” in the late 20th century [4–6].

In Malaysia, the prevalence of physical activity is 43.7%, at which women (50.5%) are more inactive than men (35.3%) [7]. Data from The Malaysian Cohort (TMC) sub-study (n=90) on physical activity using the International Physical Activity Questionnaire (IPAQ), showed that the average total activity of Malaysian was 1866 MET-min wk-1, as per measured in metabolic equivalents unit, which is slightly above average [8]. However, the reported data may subject to bias due to the small sampling size and refined study subjects [8]. Physical inactivity had contributed to the ever-increasing prevalence of obesity and overweight, the leading causes of health complications[9,10]. Among the health complications associated with physical inactivity includes diabetes, cancer, and cardiovascular disease, which are considered as the major killer in the modern era [3]. Globally, these chronic diseases contributed to 60% of deaths in 2005. Meanwhile, in Malaysia, chronic diseases accounted for 71% of all deaths in 2002 [11].

Exercise is important and beneficial for one’s health. It is a non-pharmacological and inexpensive way to manage obesity [12,13]. For example, exercise decreases the level of low-density lipoprotein (LDL, the bad cholesterol), blood pressure, risk of heart attack, stroke, cases of diabetes, and colon cancer. Furthermore, it helps to increase the level of high-density lipoprotein (HDL, the good cholesterol) that has been associated with protection against heart attack and stroke [14]. Additionally, exercise can enhance the quality of muscle strength, bone, and joint motion which helps to prevent osteoporosis [15]. It also aids in preventing aging and boosts the immune system [16]. Besides, exercise is helping us to prevent stress, depression, and insomnia, boosting our positive self-esteem (self-image) and self-confidence [17]. It also enhances our brainpower and sharpens our memory [18].

Other studies also reported that exercise can act as primary prevention or delays for 35 chronic conditions including premature death, sarcopenia, metabolic syndrome, non-alcoholic fatty liver disease, coronary heart disease, peripheral artery disease, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, osteoarthritis, rheumatoid arthritis, breast cancer, endometrial cancer, gestational diabetes, preeclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases [3,19,20]. It is also good to know that exercising in a fasting state could boost fat utilization and induce weight loss [21]. Thus, exercise does not only make you physically fit, but it also improves your overall body health and leads to a general sense of well-being [18].

Basically, exercise can be divided into four main categories which are: (I) Endurance, (II) Strength, (III) Balance, and (IV) Flexibility. Endurance or aerobic exercise includes activities that increase your breathing and heart rate. This type of exercise is good for the cardiovascular and respiratory system, as well as overall fitness. Some examples of aerobic exercises include jogging, brisk walking, and dancing. Exercise such as Tai Chi and standing on one foot are focusing on balance improvement. It is recommended for the prevention of bone fracture or falls among the older generation. Meanwhile, strength exercise is structured mainly to strengthen the muscles and enhance ability. Common examples of strength exercises are weight lifting, and bodyweight lifting using a resistance band. The fourth category of exercise is flexibility such as Yoga and calf stretch. By performing this type of exercise, flexibility and mobility could be increased.

Picture 1: Types of exercise in four main categories ‘(I) Endurance, (II) Strength, (III) Balance and (IV) Flexibility’

For overall health benefit, it is advisable to schedule and perform all these four types of exercise by the interval [18]. Depending on the overall effect on the human body, physical exercises can be generally divided into aerobic exercise and anaerobic exercise. By definition, aerobic exercise means “with oxygen” while anaerobic exercise is vice versa. Aerobic exercise is any physical movement that uses more capacity of oxygen than it would compare to the resting stage because it involved a large group of muscle. Cardiovascular conditioning is its main goal. Some popular aerobic exercise includes long-slow distance training, cycling, brisk walking, swimming, and hiking. Anaerobic exercise, on the other hand, is any short-length activity with high intensity such as weight training, sprinting, interval training, lunges, and push-ups. Anaerobic exercise will break down glucose for energy without using oxygen [22–24]. The intensity of exercise can be classified into three levels which are light, moderate, and vigorous [22].

In conclusion, it is never too late to exercise. One important study published in 2012 by Archives of Internal Medicine found that an individual with a greater fitness level in their late 50s (mid-life) will have a lower chance to develop several chronic diseases including diabetes, stroke, heart failure, and Alzheimer’s disease in their later years [25]. Therefore, start exercising now and build your own motivation!



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