what are the health benefits of aerobic exercise essay

Physical Activity Is Good for the Mind and the Body

Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion.

Everyone has their own way to “recharge” their sense of well-being — something that makes them feel good physically, emotionally, and spiritually even if they aren’t consciously aware of it. Personally, I know that few things can improve my day as quickly as a walk around the block or even just getting up from my desk and doing some push-ups. A hike through the woods is ideal when I can make it happen. But that’s me. It’s not simply that I enjoy these activities but also that they literally make me feel better and clear my mind.

Mental health and physical health are closely connected. No kidding — what’s good for the body is often good for the mind. Knowing what you can do physically that has this effect for you will change your day and your life.

Physical activity has many well-established mental health benefits. These are published in the Physical Activity Guidelines for Americans and include improved brain health and cognitive function (the ability to think, if you will), a reduced risk of anxiety and depression, and improved sleep and overall quality of life. Although not a cure-all, increasing physical activity directly contributes to improved mental health and better overall health and well-being.

Learning how to routinely manage stress and getting screened for depression are simply good prevention practices. Awareness is especially critical at this time of year when disruptions to healthy habits and choices can be more likely and more jarring. Shorter days and colder temperatures have a way of interrupting routines — as do the holidays, with both their joys and their stresses. When the plentiful sunshine and clear skies of temperate months give way to unpredictable weather, less daylight, and festive gatherings, it may happen unconsciously or seem natural to be distracted from being as physically active. However, that tendency is precisely why it’s so important that we are ever more mindful of our physical and emotional health — and how we can maintain both — during this time of year.

Roughly half of all people in the United States will be diagnosed with a mental health disorder at some point in their lifetime, with anxiety and anxiety disorders being the most common. Major depression, another of the most common mental health disorders, is also a leading cause of disability for middle-aged adults. Compounding all of this, mental health disorders like depression and anxiety can affect people’s ability to take part in health-promoting behaviors, including physical activity. In addition, physical health problems can contribute to mental health problems and make it harder for people to get treatment for mental health disorders.

The COVID-19 pandemic has brought the need to take care of our physical and emotional health to light even more so these past 2 years. Recently, the U.S. Surgeon General highlighted how the pandemic has exacerbated the mental health crisis in youth .

The good news is that even small amounts of physical activity can immediately reduce symptoms of anxiety in adults and older adults. Depression has also shown to be responsive to physical activity. Research suggests that increased physical activity, of any kind, can improve depression symptoms experienced by people across the lifespan. Engaging in regular physical activity has also been shown to reduce the risk of developing depression in children and adults.

Though the seasons and our life circumstances may change, our basic needs do not. Just as we shift from shorts to coats or fresh summer fruits and vegetables to heartier fall food choices, so too must we shift our seasonal approach to how we stay physically active. Some of that is simply adapting to conditions: bundling up for a walk, wearing the appropriate shoes, or playing in the snow with the kids instead of playing soccer in the grass.

Sometimes there’s a bit more creativity involved. Often this means finding ways to simplify activity or make it more accessible. For example, it may not be possible to get to the gym or even take a walk due to weather or any number of reasons. In those instances, other options include adding new types of movement — such as impromptu dance parties at home — or doing a few household chores (yes, it all counts as physical activity).

During the COVID-19 pandemic, I built a makeshift gym in my garage as an alternative to driving back and forth to the gym several miles from home. That has not only saved me time and money but also afforded me the opportunity to get 15 to 45 minutes of muscle-strengthening physical activity in at odd times of the day.

For more ideas on how to get active — on any day — or for help finding the motivation to get started, check out this Move Your Way® video .

The point to remember is that no matter the approach, the Physical Activity Guidelines recommend that adults get at least 150 minutes of moderate-intensity aerobic activity (anything that gets your heart beating faster) each week and at least 2 days per week of muscle-strengthening activity (anything that makes your muscles work harder than usual). Youth need 60 minutes or more of physical activity each day. Preschool-aged children ages 3 to 5 years need to be active throughout the day — with adult caregivers encouraging active play — to enhance growth and development. Striving toward these goals and then continuing to get physical activity, in some shape or form, contributes to better health outcomes both immediately and over the long term.

For youth, sports offer additional avenues to more physical activity and improved mental health. Youth who participate in sports may enjoy psychosocial health benefits beyond the benefits they gain from other forms of leisure-time physical activity. Psychological health benefits include higher levels of perceived competence, confidence, and self-esteem — not to mention the benefits of team building, leadership, and resilience, which are important skills to apply on the field and throughout life. Research has also shown that youth sports participants have a reduced risk of suicide and suicidal thoughts and tendencies. Additionally, team sports participation during adolescence may lead to better mental health outcomes in adulthood (e.g., less anxiety and depression) for people exposed to adverse childhood experiences. In addition to the physical and mental health benefits, sports can be just plain fun.

Physical activity’s implications for significant positive effects on mental health and social well-being are enormous, impacting every facet of life. In fact, because of this national imperative, the presidential executive order that re-established the President’s Council on Sports, Fitness & Nutrition explicitly seeks to “expand national awareness of the importance of mental health as it pertains to physical fitness and nutrition.” While physical activity is not a substitute for mental health treatment when needed and it’s not the answer to certain mental health challenges, it does play a significant role in our emotional and cognitive well-being.

No matter how we choose to be active during the holiday season — or any season — every effort to move counts toward achieving recommended physical activity goals and will have positive impacts on both the mind and the body. Along with preventing diabetes, high blood pressure, obesity, and the additional risks associated with these comorbidities, physical activity’s positive effect on mental health is yet another important reason to be active and Move Your Way .

As for me… I think it’s time for a walk. Happy and healthy holidays, everyone!

Yours in health, Paul

Paul Reed, MD Rear Admiral, U.S. Public Health Service Deputy Assistant Secretary for Health Director, Office of Disease Prevention and Health Promotion

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The Health Benefits of Exercise and Physical Activity

• Gastroenterology, Critical Care, and Lifestyle Medicine (SA McClave, Section Editor)
• Published: 14 July 2016
• Volume 5 , pages 204–212, ( 2016 )

Cite this article

• Keith R. Miller 1 ,
• Stephen A. McClave 2 ,
• Melina B. Jampolis 3 ,
• Ryan T. Hurt 4 ,
• Kristine Krueger 2 ,
• Sarah Landes 2 &
• Bryan Collier 5  

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Physical inactivity is a modifiable risk factor (similar to dyslipidemia and hypertension) for a variety of chronic diseases, including cancer and cardiovascular disease. Exercise provides a clear health benefit, which serves in the primary and secondary prevention of these disease processes (the most important being a reduction in cardiovascular disease and premature death). The physiologic mechanisms for such a benefit occur at both a cellular and multisystem level. Prolonged periods of occupational or leisure-time sitting have adverse health effects independent of exercise performed before or after. Almost any form of physical activity (PA) is beneficial, whether part of a regular exercise program or as a series of intermittent, incidental, non-purposeful, lifestyle-embedded activity (causing non-exercise activity thermogenesis or NEAT). The health benefits of exercise appear to be dose-dependent. Physicians should recommend near daily exercise which includes at various times strength training, stretching, and aerobic activity in addition to emphasizing adjustments that allow for reduced sitting and increased activity during daily routines. Patients should understand that for optimal health, exercise is no longer optional.

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Introduction

Physical inactivity is a modifiable risk factor for cardiovascular disease, obesity, depression, cancer, diabetes mellitus, hypertension, and osteoporosis. Physical exercise reduces the risk of premature death and prolongs longevity, and is an important treatment modality in the primary and secondary prevention of the above disorders [ 1 ]. For most states in this country, less than half of the population meets CDC exercise recommendations [ 2 •]. The decline in physical activity (PA) occurs both at work and in leisure time, and may have at least partially contributed to the increase in obesity over the past 30 years. Low recreational physical activities have been associated with a threefold increase for major weight gain in men and a fourfold increase in women [ 3 ]. Surveys of PA across the lifecycle show that physical exercise peaks in the middle high-school age range and begins declining through high school and into adult life. A vicious cycle of decline occurs between inactivity and loss of skeletal muscle mass which accelerates with age. With avoidance of activity requiring effort, there is increased loss of exercise capacity. This loss causes the perception of effort associated with even sub-maximal work to worsen, as the anaerobic threshold decreases. The vicious cycle contributes to further inactivity and deterioration of physical function. The only treatment that can break the cycle is exercise.

Impact of Exercise on Aging

Exercise provides powerful health benefits for quality of life, physical function, and independent living throughout the life cycle. Exercise impedes the aging process and promotes longevity. Observational studies have shown that even in the presence of disease processes such as hypertension (HTN), chronic obstructive pulmonary disease (COPD), diabetes, smoking, high body mass index (BMI), and hypercholesterolemia, increasing PA has a dose-dependent effect in decreasing relative risk of death [ 4 ]. In a study of subjects over a 13-year time period, both baseline fitness, and improvement in physical fitness through exercise and PA was associated with significant increases in longevity [ 4 ]. Functional independence with advanced age relates to the overall level of physical fitness. Physical fitness is most affected by the status of the cardiorespiratory and vascular systems, as well as muscle function [ 5 •].

Garatachea et al. provide an excellent review of the effect of exercise on the physiologic changes associated with aging [ 5 •]. Exercise exerts its positive influence on both a cellular level and at the level of organ systems. At the cellular level, exercise helps reduce genomic instability, epigenetic alteration, loss of proteostasis, dysregulated nutrient sensing, cellular senescence, and altered intracellular communication that leads to inflammation. These effects alter the way the body performs transcellular signaling in the skeletal muscle, the turning on and off of genes through epigenetics, and the manner in which the system manages reactive oxygen species [ 5 •]. On a multisystem level, the benefits of exercise include improvement in brain, cardiovascular, lung, and muscle function, favorable alterations in body composition, and advantageous changes in metabolic responses. The report concludes by suggesting that in the future, pharmaceuticals should be designed which mimic the effects of exercise on the aging process [ 5 •].

Effect of Exercise on Treatment of Disease

Robert Butler from the National Institute on Aging has said that “If exercise could be put in a bottle, it would be the strongest medicine money could buy” [ 6 ]. Exercise helps prevent common chronic diseases (primary prevention), and often plays an important role in the treatment of these disease processes (secondary prevention). Specific benefits from exercise have been seen with cardiovascular disease, stroke, diabetes mellitus, depression, cancer, obesity, and osteoporosis [ 7 , 8 ]

Cardiovascular Disease

Increased levels of PA and physical fitness have a graded effect in reducing the risk of death from cardiovascular disease. The relative risk from all cause and cardiovascular disease mortality is reduced 20–35 % by exercise and PA [ 9 ]. In an observational study, subjects in the lowest quintile of exercise had a relative risk of 3.4 in men and 4.7 in women for death compared to those in the highest quintile [ 10 ]. An increase in activity-related energy expenditure by as little as 1000 kcal or 1 metabolic equivalent (MET)-hour of exercise per week has a mortality benefit of 20 % [ 11 ]. Physically inactive women have a 52 % increase in death, a cardiovascular disease-related death that is doubled, and a cancer-related death rate that is increased by 29 % [ 11 ]. These risks on mortality from inactivity are similar to other modifiable risk factors such as HTN, hypercholesterolemia, and obesity. In randomized controlled trials (RCT)s, exercise and PA are valuable for the secondary prevention of cardiovascular disease. Whereas in the past, traditional recommendations for patients with a heart attack included rest and physical inactivity. Newer information demonstrates that exercise actually attenuates or reverses risk of cardiovascular disease [ 12 ]. The benefit of exercise is seen in cardiac rehabilitation, where increasing PA reduces the risk of premature death following a myocardial infarction [ 12 ]. Added energy expenditure of 1600 kcal/week from exercise may halt the progression of heart disease and energy expenditure of >2200 kcal/week can lead to plaque reduction [ 13 ]. The minimum training recommendation for patients following myocardial infarction is to reach 45 % of their heart rate reserve through cardiac rehabilitation [ 12 , 13 ].

Multiple mechanisms have been identified whereby exercise reduces the risk of premature death [ 4 ]. Exercise affects body composition by decreasing abdominal adiposity and improving weight control. Exercise enhances lipid profiles by reducing serum triglyceride levels, raising HDL, and reducing the LDL/HDL ratio. In addition, a recent meta-analysis showed beneficial changes in lipoprotein subclasses associated with regular exercise including a reduction in small LDL-p and an increase in large LDL-p [ 14 ]. Exercise enhances hemodynamics by decreasing blood pressure, increasing cardiac function, and improving coronary blood flow. Autonomic tone is enhanced and shear stress-mediated endothelial function is improved. Exercise reduces systemic inflammation, as evidenced by reduced C-reactive protein (CRP) levels. Improved psychological well-being in response to exercise is associated with reduced stress, anxiety, and depression [ 4 ].

PA is inversely correlated with risk of incident stroke as shown in a large nurses’ health study [ 15 ]. Habitual exercise reduces risk of stroke by 40–50 % at the highest level of PA. Change in PA is protective against stroke as evidenced by the fact that an increase of 3.5 h of exercise or PA per week is associated with a 29 % reduction in ischemic stroke [ 15 ].

Diabetes Mellitus

Exercise is valuable in both the primary and secondary prevention of diabetes mellitus. Aerobic and resistant-type exercise reduces the likelihood of developing type-2 diabetes mellitus. For each 500 kcal of energy expended per week, there is an associated 6 % reduction in the likelihood of type-2 diabetes (which may be even greater with increasing BMI) [ 16 ]. In patients already diagnosed to have diabetes mellitus, walking 2 h per week is associated with a 39–54 % reduction in all-cause mortality from diabetes mellitus, and a 34–53 % reduction in mortality related to cardiovascular disease [ 17 ]. The benefit of exercise on glycemic control appears to be greater with resistance training than aerobic exercise. A meta-analysis of exercise and PA in diabetes showed that exercise reduces hemoglobin A1C by 0.66 %, an effect similar to intensive glucose-lowering pharmacologic therapy [ 18 ]. The mechanisms by which exercise benefits diabetes relate to the fact that exercise increases glycogen synthetase and hexokinase activity [ 4 ]. Exercise reduces GLUT-4 protein and messenger RNA expression and increases muscle capillary density, which helps improve glucose delivery to the muscle [ 4 ].

Increasing PA, either occupational or at leisure, has been shown to exert a primary preventative effect on two cancers—breast and colon cancer [ 19 ]. Moderate exercise of as little as 4–5 METs (equivalent to mowing the lawn or brisk walking), is required to achieve this effect [ 20 ]. Exercise is associated with a 20–30 % reduction in the incidence of breast cancer in women, and a 30–40 % reduction in the incidence of colon cancer in both men and women [ 20 ]. In those patients already diagnosed to have one of these cancers, exercise reduces the likelihood for cancer recurrence and reduces risk from cancer death by as much as 26–40 % [ 21 ]. PA improves quality of life and overall health status in cancer patients. The mechanisms by which exercise improves risk from cancer may relate to reduced fat stores, an increase in energy expenditure offsetting a high-fat diet, activity-related changes in sex hormone levels, improvement in immune function, and reduced generation of free oxygen radicals [ 4 ].

Osteoporosis

Exercise has a valuable effect in the primary prevention of osteoporosis. Routine PA minimizes age-related bone loss. Weight-bearing exercise (especially resistance exercise) increases bone density compared to low impact non-weight-bearing exercise. Exercise prevents 1 % of bone loss per year, an effect which is greater in post-menopausal than pre-menopausal women [ 22 ]. In RCTs, exercise reduces the risk and number of falls, as well as the risk of fracture [ 22 ]. Even in men, PA reduces the risk of fracture by 62 % over the age of 21 years [ 23 ]. Exercise is also valuable in the secondary prevention of osteoporosis. RCTs in the past have shown that exercise with resistance training increases bone density in older osteoporotic women by as much as 1.4 %, while agility training alone increases bone density by 0.5 % [ 24 ]. Stretching, which was used as sham control, was shown to have no effect on the expected decrease in bone density with age [ 24 ]. In a 12-year follow up of over 60,000 post-menopausal women, risk of hip fracture was lowered 6 % for each increase of three MET-hours per week of activity (the equivalent of walking three miles in 1 h) [ 25 ]. Active women with at least 24 met-hours of exercise per week had a 55 % lower risk of hip fracture than sedentary women with no other exercise. Walking at least 4 h per week was associated with a 41 % lower risk of hip fracture than walking less than one hour per week [ 25 ].

Exercise has a valuable therapeutic effect on the treatment on multiple types of depression, including dysthymic, seasonal, bipolar, post-natal, pre-menstrual, atypical, and major depression [ 26 ]. The value in treating depression comes from an innate anti-depressive effect from exercise. Combining exercise with psychotropic medications achieves better treatment results than the same medications alone [ 26 ]. Exercise is relatively inexpensive, safe, and has minimal side effects when done correctly. Exercise may help reduce the dose of anti-depressive medications required. Subjects are less likely to relapse with an active exercise program [ 26 ].

The patients with depression who are most likely to benefit from exercise include those with age <20 or >40 years, higher education, higher baseline physical status, females, untrained subjects, and those with mild to moderate depression [ 26 ]. There are a number of aspects of exercise that get the optimal results in treating depression including programs that are structured, individually tailored to the patient, low to moderate intensity, when it is used as an adjunct to medication therapy, and exercise that is a combination of aerobic or resistive training performed 3–4 times per week [ 26 ]. The mechanism of effect from exercise on depression occurs on a systemic level as well as a direct effect on central nervous system (CNS) function. Exercise appears to increase serotonin, ACTH, endorphins, and endocannabinoids within the CNS. On a systemic level, exercise increases norepinephrine and reduces cortisol, tumor necrosis factor (TNF), and interleukin-6 [ 26 ].

In a controversial article that appeared in Time magazine in 2009, the journalist John Cloud wrote about “The Myth of Exercise” and its effect on treating obesity [ 27 ]. The article suggested that exercise was not good for weight management in obesity. The author pointed out that exercise leads to increased appetite and intake of food and causes a decrease in non-exercise energy expenditure, and therefore that exercise was a poor strategy for weight loss [ 27 ]. A number of letters to the editor of Time magazine followed the publication of this article, including letters from the American Society for Sports Medicine, arguing that facts were misrepresented and that the article gave the wrong message about the health benefits of exercise.

A recent review by Swift clarified the role of exercise in managing or preventing obesity, and suggested that Cloud’s article was in fact an accurate portrayal of the facts [ 28 ]. The key issue of Swift’s review is that exercise without caloric restriction is unlikely to succeed in weight loss [ 28 ]. Increasing PA can prevent weight gain, but it requires 150–250 min per week of moderate to vigorous exercise or 1200–2000 kcal/week expended through exercise to accomplish this feat [ 29 ]. Aerobic exercise by itself is minimally helpful in promoting weight loss, successful in loss of only 0–2 kg total [ 29 ]. Extreme high-volume aerobic exercise can achieve significant weight loss, but this is usually unsustainable by most obese patients. Moderate intensity, surprisingly, is no different than vigorous intensity in achieving weight loss, unless subjects are matched for exercise duration. Resistance training by itself has no impact on weight loss, and aerobic training combined with resistant training has no greater effect than aerobic training alone. However, adding caloric restriction to aerobic training does result in successful weight loss of 9–13 kg, and higher intensity of exercise has the potential for even greater weight loss [ 29 ]. Some obese subjects do experience weight compensation in response to exercise, defined by the circumstances where less weight is lost than expected with the amount of exercise sustained, often a factor related to an increase in caloric intake [ 28 , 30 ]. This is more likely to occur in women performing 150 % of weekly recommendations (compared to women performing only 100 % or 50 % of weekly recommendations) [ 28 , 30 ]. Even if minimal or no weight loss occurs in response to exercise, obese subjects still benefit from the increase in PA due to increased cardiorespiratory fitness, glucose control, endothelial function, improvements in hyperlipidemia, quality of life, and a reduction in future weight gain [ 28 ].

Caloric restriction is better than exercise for significant weight loss initially, and the weight loss is not necessarily enhanced significantly by adding exercise [ 28 ], although exercise training plus caloric restriction does improve body composition by increasing fat loss and decreasing loss of lean body mass [ 31 ]. The greatest value of exercise in the management of obesity occurs not in the initial weight loss, but in the situation where obese patients have lost weight successfully and now require substantial PA to maintain that weight loss [ 28 ]. Interestingly, an “energy gap” has been identified as the difference in energy expenditure before and after weight loss [ 32 ]. The energy gap is estimated to be approximately 8 kcal per day per pound of weight lost. An energy gap, for example, of 40 lbs lost would be associated with 320 kcal of energy. Sustaining this weight loss successfully would require either a continued reduction in energy consumption by 320 kcal per day, or increasing activity-associated energy expenditure by the same amount [ 32 ]. Based on the Set Point theory, both biological and environmental pressures oppose the strategy of food restriction in keeping weight off, but the same effect does not occur with increased PA [ 32 ]. Therefore, while food restriction is the key to weight loss, PA is the key to successful maintenance of the weight lost [ 32 ]. The ACSM has identified that people who successfully maintain weight loss average at least 250 min of PA per week [ 29 ].

Low Back Pain

A 2016 systematic review and meta-analysis reviewed 23 randomized controlled trials evaluating the prevention of low back pain [ 33 ]. Over 30,000 patients were involved in these studies. Ultimately, the combination of exercise (varying regimens of abdominal strengthening, core stability, cardiovascular, and isometrics) plus education regarding prevention of low back pain was found to reduce the risk of low back pain as well as sick leave related to low back pain. Exercise alone was also found to have an impact but had a more short term effect (<12 months), thought to be due to cessation of exercise following the intervention. Other interventions, including back belts, insoles, and education alone were not found to have any impact [ 33 ].

Not All Exercise is Created Equal

Physical activity versus physical fitness.

The lay public tends to use the terms PA and physical fitness interchangeably, but subtle differences between the two exist. Physical fitness is a physiologic state of being with regard to daily living and/or sports performance [ 4 ]. Physical fitness is comprised of cardiovascular, musculoskeletal, body composition, and metabolic components [ 4 ]. Physical fitness is similar to PA, but is more predictive of health outcomes. For example, a high-fit versus a low-fit person is estimated to have a 50 % lower mortality [ 34 ]. Physical fitness, therefore, becomes a better measure of PA than self-reporting. From a public health standpoint, however, it is better and more productive to encourage the public to be physically active and not push the need to be physically fit. Eventually, increased activity should lead to physical fitness.

In the past, guidelines for optimal health seemed to have had a singular focus on aerobic fitness. But a new paradigm shift has occurred with the addition of the concept of musculoskeletal fitness [ 4 ]. In other words, health status can improve due to increased PA in the absence of changes in aerobic fitness. Regular PA can decrease risk factors from chronic disease and disability without changing cardiac output or oxidative potential, especially in the elderly [ 4 ]. The shift has been to focus on the health benefits of musculoskeletal fitness, which may be a critical factor in the functional threshold for dependence with the aging population. Loss of muscular fitness can result in loss of capacity for daily living, and a cycle of decline can ensue [ 4 ]. Improvement in musculoskeletal function can delay the onset of disability, dependence, and chronic disease [ 35 ]. Musculoskeletal fitness is associated with fewer functional limitations and a reduced incidence of cardiovascular disease, diabetes, degenerative joint disease, and coronary artery disease [ 35 ]. Therefore, resistance training that works all the major muscle groups (including legs, hips, back, abdomen, chest, shoulders, and arms) and flexibility exercise, which are necessary to achieve musculoskeletal fitness, are recommended to be done at least twice weekly, to complement aerobic fitness and optimize overall health status.

Adverse Health Risk from Sitting

In an effort to delineate those factors which contribute to the obesity epidemic, researchers are increasingly focused on the adverse health risk from prolonged sitting [ 36 •]. A newly recognized occupational hazard has evolved because of workers needing to sit at a computer screen throughout the workday. Each mean hour of sitting after a total mean of 7 h per day is associated with a 5 % increase in premature death [ 36 •]. More time sitting at work has been shown to correlate with more sitting in leisure time. Prolonged sitting while watching TV at home, for example, has adverse effects on mental health, well-being, and muscle strength. Long sedentary hours have been linked to a twofold increase in diabetes, a twofold increase in cardiovascular disease, a 13 % increase in the incidence of cancer, and a 17 % increase in mortality related to cancer [ 36 •]. It is estimated that the average worker in the USA and England spends 60–70 % of waking hours in a sedentary sitting position. The effect of sitting has been likened to the transmission of a car. Sitting for such a prolonged period is like putting a car in reverse, causing one’s overall health status to go in the wrong direction [ 36 •]. Approximately 20–30 % of the time is spent in light intensity activity, described as postural changes, standing and movement, or ambulation. For less than 5–10 % of waking hours, individuals spend in moderate to vigorous PA. The adverse effect of sitting on health status is independent of the exercise or PA done before or after [ 36 •]. In other words, no amount of PA later can overcome the negative health effects of prolonged sitting.

Changes in the workplace environment may be the key issue to minimizing the negative effects of prolonged sitting. Particularly, in the UK, recommendations and guidelines have been developed to avoid this health hazard [ 36 •]. Workers are encouraged to accumulate up to 2 h per day at work standing or performing light walking, with the goal to progress ultimately to 4 h per day. Workers should interrupt seat-based work with standing-based work. However, workers should avoid both prolonged periods of standing as well as prolonged periods of sitting. Adaptation of these guidelines may lead to musculoskeletal complaints and fatigue, which should be monitored by managers in the workplace. Such health promotion strategies should eventually extend from the workplace to the leisure time [ 36 •].

Non-Exercise Activity Thermogenesis

Non-exercise activity thermogenesis (NEAT) has been described as unstructured PA, energy expended unrelated to sleeping, eating, or sports exercise. NEAT is energy expended outside of purposeful exercise [ 37 ]. Surprisingly, this incidental, non-purposeful lifestyle-embedded PA can have tremendous health benefits. Three components of NEAT include body posture, ambulation, and all other movements (the most important of which may be fidgeting) [ 38 ]. Researchers involved in the study of obesity are finding that in some cases what delineates the lean subject from an obese one is a difference in NEAT, not exercise-associated activity thermogenesis [ 38 ]. Early experiments which helped identify NEAT came from studies where energy requirements were measured and all subjects were placed on a diet of 1000 cal over requirements [ 39 ]. Subjects were then videotaped, and in a blinded fashion designated as fidgeters or non-fidgeters. At the end of the trial, those patients who were designated as fidgeters failed to gain weight, while those identified to be non-fidgeters sustained significant weight gain. The increase in kilocalories of energy expenditure attributed to NEAT was inversely proportional to fat gain in pounds [ 39 ]. NEAT ranges from 15 % of total energy expenditure (TEE) in sedentary subjects to as much as 50 % of TEE in fidgeting physically active people [ 39 ]. Fidgeting has been shown in twin studies to be genetic, with an estimated >62 % heritability [ 40 ]. Simply standing or lightly ambulating can increase energy expenditure by an average of 350 kcal/day (range 269–477 kcal/day) [ 37 ]. NEAT tends to be greater in men than women, in obese subjects rather than lean, and in those with more education than those with less [ 38 , 39 ]. NEAT tends to be seasonal and overall, declines with age [ 39 ]. The concept of an energy gap is pertinent to NEAT. An average citizen in the USA has been shown to gain 1–2 lbs each year through their adult life. An energy gap of 100 kcal additional energy consumed each day would account for this weight gain [ 41 ]. NEAT can be an important contributor to TEE, such that increases in NEAT of as little as 100–150 kcal of activity per day could prevent such weight gain (by offsetting the energy gap) in the vast majority of people [ 41 ]. Recommendations now suggest that if you were not lucky enough to inherit fidgeting, you should “act like a fidgeter,” standing often, getting up from sitting, pacing, parking at the back of a parking lot, and taking stairs instead of elevators [ 40 ].

Continuous Versus Interval Exercise

Long bouts of continuous exercise as a strategy for weight loss or weight maintenance can be a contentious and challenging recommendation for the general public. Longer duration, continuous exercise may be difficult and not particularly enjoyable for patients and may not fit as well with work or home schedules. Research now has shown that interval exercise, which involves alternating short bouts of high-intensity exercise with lower-intensity exercise that allows for partial recovery, can match the health benefits of continuous exercise [ 42 ]. Studies in patients with class-1 obesity (BMI 30–34.9 kg/m 2 ), walking at a moderate level of intensity, randomized to two 15-min intervals of walking versus one 30-min interval, showed essentially the same improvements in overall health status [ 42 ]. Both intermittent and continuous exercise resulted in improvement of maximum oxygen consumption, body composition, and lipid profiles. In some categories, interval exercise even exceeded the benefit seen with continuous exercise (such as VLDL levels and percent fat lost) [ 42 ]. The value of these findings for intermittent exercise stems from three factors: there is less attrition with recommendations for interval exercise, time constraints, and short periods of interval exercising may allow for greater intensity of PA [ 42 ]. An additional study involving 28 sedentary overweight or obese men compared five 45- to 60-min sessions of continuous moderate intensity cycling per week for 6 weeks with three 20-min sessions of high-intensity interval exercise per week (for a total of 60 min) for 6 weeks. Similar improvements in cardio-metabolic risk factors including improved insulin sensitivity, cardiovascular fitness, and a reduction in blood lipids and body fat percentage were observed in the groups [ 43 ]. While cardiovascular fitness was improved to a greater extent in the continuous exercise group, this study, along with numerous other studies of interval exercise showing similar outcomes in different populations, are encouraging in that they show many of the same improvements in overall health with a substantially reduced time commitment [ 43 ]. This is especially relevant as lack of time is cited as the most common reason for not exercising by many. In addition, interval exercise can be easily adapted to an individual’s starting fitness level by adjusting either the duration or intensity (or both) of the high-intensity component of exercise. This may be especially beneficial for sedentary overweight or obese individuals who are new to exercise. In light of both the potential health and time saving benefits, interval exercise training appears to be an appealing and worthwhile exercise option in addition to, or instead of, continuous exercise. The good news for public health is that short walks on a subject’s lunch break or brief periods of activity before and after work all count, and the sum of their duration may have similar benefits to a single continuous interval of exercise of the same duration.

Success of Pedometers

The use of pedometers to increase PA was generated years ago in Japanese walking clubs. The rationalization for the pedometer was that the average stride was estimated to be 2.5 ft. Therefore, 2000 steps should approximately equal a mile, 10,000 equaling about 5 miles [ 44 ]. Based on this rationalization, PA can be classified as sedentary (<5000 steps per day), low active (5000 to 7500 steps), somewhat active (7500 to 10,000 steps), and active (>10,000 steps per day). Highly active physical exercise is associated with >12,500 steps per day [ 44 ]. This is an arbitrary categorization, however, and 10,000 steps per day may be too little for children or too much for the elderly. Weight loss using a pedometer without caloric restriction is associated with minimal to modest weight loss of <2 kg [ 44 ]. Health benefits associated with use of the pedometer may be limited to a reduction in blood pressure, with not much change in cholesterol, triglycerides, or fasting glucose [ 44 ].

Exercise in the Intensive Care Unit

Exercise is becoming increasingly important in one of the least expected circumstances, that of a critically ill patient in the intensive care unit (ICU). Researchers have found that exercising muscle increases the uptake of amino acid fuel and promotes greater protein synthesis [ 45 , 46 ]. Patients in the ICU on a ventilator in some centers are gotten out of bed and encouraged to walk with assistance in the hallway. Other centers have used a pedaling device, some of which can even be adapted for passive activity in a patient who is otherwise sedated and minimally responsive. Exercise in the critical care setting helps maintain muscular strength, reduces the risk for long-term neuromuscular weakness, shortens rehabilitation, and is more likely to result in the patient being discharged to their home [ 45 , 46 ].

Recommendations for Public Health

Similar to the Food Guide Pyramid designed by the USDA, an activity pyramid has been created to guide the public in strategies to increase flexibility, muscular strength, and aerobic capacity ( www.wellspan.org/media/3648/activitypyramid-2009.pdf ). Every day, subjects are encouraged to increase activity in leisure and at work. Three to five times per week, aerobic activity should occur, accumulating 150 min each week ( www.wellspan.org/media/3648/activitypyramid-2009.pdf ). Two to three times per week, muscular activity focusing on flexibility and strength training should be scheduled. Sitting more than 30 min at a time, watching TV, or staring at a computer screen should be minimized or reduced as much as possible ( www.wellspan.org/media/3648/activitypyramid-2009.pdf ).

Guidelines differentiate between moderate and vigorous intensity of PA. Moderate intensity is defined by a 3–5 MET level of effort, and includes activities that cause some increase in breathing and heart rate (such as walking 3–4 miles per hour, bicycling on level ground, light swimming, gardening, or mowing a lawn) [ 4 ]. Vigorous intensity is defined by ≥6 METs, and is exemplified by activities causing large increases in breathing, heart rate, and sweating. Such activities of vigorous intensity would include jogging or running at faster than a 10 min mile, aerobic dancing, competitive sports, heavy yard or construction work, brisk swimming, or fast bicycling [ 4 ].

The amount of PA needed to optimize health is not clear. The particular dose of exercise required to achieve benefits with regard to a particular disease process is difficult to ascertain. For cardiovascular disease, the intensity of PA is inversely and linearly associated with increased mortality, with the biggest effect seen as a reduction of premature death [ 47 ]. PA of >2000 kcal per week extends life by 1–2 years by age 80 [ 47 ]. An average energy expenditure of 1000 kcal per week is associated with a 20–30 % decrease in all-cause mortality. Beginning at a minimum of 1000 kcal per week, increasing benefits are seen with increasing energy expenditure, suggesting a dose-response gradient to the effect of exercise on cardiovascular health [ 47 ]. For diabetes mellitus, there is decreased risk from this disease process with PA of >5.5 METs for at least 40 min per week [ 48 ]. Walking 2 h per week decreases the risk of premature death from diabetes [ 48 ]. Moderate exercise defined by a >4.5 METs for 30–60 min per day reduces both the risk of colon cancer and breast cancer [ 19 ]. For women in particular, >7 h per week of moderate exercise has been shown to be successful in reducing risk of breast cancer (TI01). For osteoporosis, the dose-response gradient is less clear, with recommendations simply emphasizing that osteogenic adaptation is load-dependent and site-specific [ 4 ]. The Center for Disease Control (CDC), the American College of Sports Medicine, and the Healthy People 2010 recommendations provide guidelines for aerobic activity for public health purposes [ 49 ]. Adults should engage in PA of moderate intensity for at least 150 min per week or engage in PA of vigorous intensity for at least 75 min per week. Bouts of exercise may be broken up into smaller increments lasting at least 10 min [ 49 ].

Should Anyone Not be Exercising?

Jim Fixx was a celebrity journalist who helped contribute to the running craze seen in the 1980s in the USA. His sudden death from cardiovascular disease, while jogging, raised questions as to the need for medical evaluation prior to engaging in a program of increasing PA. Moderately strenuous PA may trigger ischemic events, particularly among sedentary people. There is an increased incidence of primary heart attack in high-intensity exercise. In competitive athletes, 80 % of deaths are caused by coronary artery disease. Some subjects do need to have their health risks assessed prior to engaging in an aggressive program.

The degree to which a person is evaluated prior to exercise depends on the presence or absence of cardiovascular disease risk factors and whether the exercise will be moderate or vigorous in intensity [ 50 ]. Subjects at low risk would be those who are young in age (<45 years for male, <55 years for female), are asymptomatic, and have ≤1 cardiovascular risk disease factors. These patients do not need a medical evaluation or stress test for moderate or even vigorous exercise. Subjects at moderate risk are older (men >45 years, women >55 years), or have ≥2 risk factors for cardiovascular disease. For moderate exercise, no medical evaluation may be needed, but these subjects should undergo a stress test. If exercise of vigorous intensity is planned, both a medical evaluation and a stress test should be performed. For those patients at high risk, however, defined by ≥1 sign or symptom of cardiovascular, pulmonary, or metabolic disease, both a full medical evaluation and stress test should be performed before any program is undertaken [ 50 ].

Specifically, those subjects who should not be exercising are those experiencing an acute myocardial infarction, subjects with unstable angina, systolic blood pressure >180, diastolic pressure >110 ml/Hg, uncontrolled diabetes mellitus, poorly controlled congestive heart failure, or thrombophlebitis [ 50 ].

While formal studies have shown that physician counseling is time-intensive and only minimally effective in changing behavior, physicians should no longer avoid the subject of recommendations for exercise as part of the healthcare they deliver to their patients. Physicians can begin by suggesting lifestyle changes such as climbing stairs at work, parking further away from the door on errands, walking regularly, and doing chores at home and in the yard. Clinicians should write on a prescription pad for the patient, specifying the type of exercise, duration, frequency, and intensity. The physician upon discharge from an office visit should determine plans for support and follow up to encourage success, manage obstacles, and prevent relapses. Clinicians should encourage their outpatients to involve community services such as physical therapy, mall-walking programs, school tracks, safe neighborhoods, the YMCA, and walk-a-thon’s.

Physicians should counsel that exercise is not an option. The exercise does not have to be continuous to be effective, and any physical activity counts. Patients should sit less, stand more, and plan their exercise activity at the beginning of each week. Subjects should be encouraged to find activities which they enjoy and involve others to maintain compliance. As Edward Stanley, the Earl of Derby in 1873 said, “Those who think they have not time for bodily exercise will sooner or later have to find time for illness” [ 51 ].

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Miller, K.R., McClave, S.A., Jampolis, M.B. et al. The Health Benefits of Exercise and Physical Activity. Curr Nutr Rep 5 , 204–212 (2016). https://doi.org/10.1007/s13668-016-0175-5

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Benefits of Physical Activity

Obesity and Excess Weight Increase Risk of Severe Illness; Racial and Ethnic Disparities Persist

Food Assistance and Food Systems Resources

Immediate Benefits

Weight management, reduce your health risk, strengthen your bones and muscles, improve your ability to do daily activities and prevent falls, increase your chances of living longer, manage chronic health conditions & disabilities.

Regular physical activity is one of the most important things you can do for your health. Being physically active can improve your brain health , help manage weight , reduce the risk of disease , strengthen bones and muscles , and improve your ability to do everyday activities .

Adults who sit less and do any amount of moderate-to-vigorous physical activity gain some health benefits. Only a few lifestyle choices have as large an impact on your health as physical activity.

Everyone can experience the health benefits of physical activity – age, abilities, ethnicity, shape, or size do not matter.

Some benefits of physical activity on brain health [PDF-14.4MB] happen right after a session of moderate-to-vigorous physical activity. Benefits include improved thinking or cognition for children 6 to 13 years of age and reduced short-term feelings of anxiety for adults. Regular physical activity can help keep your thinking, learning, and judgment skills sharp as you age. It can also reduce your risk of depression and anxiety and help you sleep better.

Both eating patterns and physical activity routines play a critical role in weight management. You gain weight when you consume more calories through eating and drinking than the amount of calories you burn , including those burned during physical activity.

To maintain your weight:  Work your way up to 150 minutes a week of moderate physical activity, which could include dancing or yard work. You could achieve the goal of 150 minutes a week with 30 minutes a day, 5 days a week.

People vary greatly in how much physical activity they need for weight management. You may need to be more active than others to reach or maintain a healthy weight.

To lose weight and keep it off: You will need a high amount of physical activity unless you also adjust your eating patterns and reduce the amount of calories you’re eating and drinking. Getting to and staying at a healthy weight requires both regular physical activity and healthy eating.

See more information about:

• Getting started with weight loss .
• Getting started with physical activity .
• Improving your eating patterns .

Learn more about the health benefits of physical activity  for children, adults, and adults age 65 and older.

See these tips  on getting started.

The good news [PDF-14.5MB]  is that  moderate physical activity , such as brisk walking, is generally  safe for most people .

Cardiovascular Disease

Heart disease and stroke are two leading causes of death in the United States. Getting at least 150 minutes a week of moderate physical activity can put you at a lower risk for these diseases. You can reduce your risk even further with more physical activity. Regular physical activity can also lower your blood pressure and improve your cholesterol levels.

Type 2 Diabetes and Metabolic Syndrome

Regular physical activity can reduce your risk of developing type 2 diabetes  and metabolic syndrome. Metabolic syndrome is some combination of too much fat around the waist, high blood pressure, low high-density lipoproteins (HDL) cholesterol, high triglycerides, or high blood sugar. People start to see benefits at levels from physical activity even without meeting the recommendations for 150 minutes a week of moderate physical activity. Additional amounts of physical activity seem to lower risk even more.

Infectious Diseases

Physical activity may help reduce the risk of serious outcomes from infectious diseases, including COVID-19, the flu, and pneumonia. For example:

• People who do little or no physical activity are more likely to get very sick from COVID-19 than those who are physically active. A CDC systematic review [PDF-931KB] found that physical activity is associated with a decrease in COVID-19 hospitalizations and deaths, while inactivity increases that risk.
• People who are more active may be less likely to die from flu or pneumonia. A CDC study found that adults who meet the aerobic and muscle-strengthening physical activity guidelines are about half as likely to die from flu and pneumonia as adults who meet neither guideline.

Some Cancers

Being physically active lowers your risk for developing several common cancers .  Adults who participate in greater amounts of physical activity have reduced risks of developing cancers of the:

• Colon (proximal and distal)
• Endometrium
• Esophagus (adenocarcinoma)
• Stomach (cardia and non-cardia adenocarcinoma)

If you are a cancer survivor, getting regular physical activity  not only helps give you a better quality of life, but also improves your physical fitness.

Learn more about Physical Activity and Cancer

As you age, it’s important to protect your bones, joints, and muscles – they support your body and help you move. Keeping bones, joints, and muscles healthy can help ensure that you’re able to do your daily activities and be physically active.

Muscle-strengthening activities like lifting weights can help you increase or maintain your muscle mass and strength. This is important for older adults who experience reduced muscle mass and muscle strength with aging. Slowly increasing the amount of weight and number of repetitions you do as part of muscle strengthening activities will give you even more benefits, no matter your age.

Everyday activities include climbing stairs, grocery shopping, or playing with your grandchildren. Being unable to do everyday activities is called a functional limitation. Physically active middle-aged or older adults have a lower risk of functional limitations than people who are inactive.

For older adults, doing a variety of physical activity improves physical function and decreases the risk of falls or injury from a fall . Include physical activities such as aerobic, muscle strengthening, and balance training. Multicomponent physical activity can be done at home or in a community setting as part of a structured program.

Hip fracture is a serious health condition that can result from a fall. Breaking a hip have life-changing negative effects, especially if you’re an older adult. Physically active people have a lower risk of hip fracture than inactive people.

See physical activity recommendations for different groups, including:

• Children age 3-5 .
• Children and adolescents age 6-17 .
• Adults age 18-64 .
• Adults 65 and older .
• Adults with chronic health conditions and disabilities .
• Healthy pregnant and postpartum women .

An estimated 110,000 deaths  per year could be prevented if US adults ages 40 and older increased their moderate-to-vigorous physical activity by a small amount. Even 10 minutes more a day would make a difference.

Taking more steps a day also helps lower the risk of premature death from all causes. For adults younger than 60, the risk of premature death leveled off at about 8,000 to 10,000 steps per day. For adults 60 and older, the risk of premature death leveled off at about 6,000 to 8,000 steps per day.

Regular physical activity can help people manage existing chronic conditions and disabilities. For example, regular physical activity can:

• Reduce pain and improve function, mood, and quality of life for adults with arthritis.
• Help control blood sugar levels and lower risk of heart disease and nerve damage for people with type 2 diabetes.
• Health Benefits Associated with Physical Activity for People with Chronic Conditions and Disabilities [PDF-14.4MB]
• Key Recommendations for Adults with Chronic Conditions and Disabilities [PDF-14.4MB]

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• Research article
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• Published: 16 November 2020

Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews

• Pawel Posadzki 1 , 2 ,
• Dawid Pieper   ORCID: orcid.org/0000-0002-0715-5182 3 ,
• Ram Bajpai 4 ,
• Hubert Makaruk 5 ,
• Nadja Könsgen 3 ,
• Annika Lena Neuhaus 3 &
• Monika Semwal 6  

BMC Public Health volume  20 , Article number:  1724 ( 2020 ) Cite this article

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Sedentary lifestyle is a major risk factor for noncommunicable diseases such as cardiovascular diseases, cancer and diabetes. It has been estimated that approximately 3.2 million deaths each year are attributable to insufficient levels of physical activity. We evaluated the available evidence from Cochrane systematic reviews (CSRs) on the effectiveness of exercise/physical activity for various health outcomes.

Overview and meta-analysis. The Cochrane Library was searched from 01.01.2000 to issue 1, 2019. No language restrictions were imposed. Only CSRs of randomised controlled trials (RCTs) were included. Both healthy individuals, those at risk of a disease, and medically compromised patients of any age and gender were eligible. We evaluated any type of exercise or physical activity interventions; against any types of controls; and measuring any type of health-related outcome measures. The AMSTAR-2 tool for assessing the methodological quality of the included studies was utilised.

Hundred and fifty CSRs met the inclusion criteria. There were 54 different conditions. Majority of CSRs were of high methodological quality. Hundred and thirty CSRs employed meta-analytic techniques and 20 did not. Limitations for studies were the most common reasons for downgrading the quality of the evidence. Based on 10 CSRs and 187 RCTs with 27,671 participants, there was a 13% reduction in mortality rates risk ratio (RR) 0.87 [95% confidence intervals (CI) 0.78 to 0.96]; I 2  = 26.6%, [prediction interval (PI) 0.70, 1.07], median effect size (MES) = 0.93 [interquartile range (IQR) 0.81, 1.00]. Data from 15 CSRs and 408 RCTs with 32,984 participants showed a small improvement in quality of life (QOL) standardised mean difference (SMD) 0.18 [95% CI 0.08, 0.28]; I 2  = 74.3%; PI -0.18, 0.53], MES = 0.20 [IQR 0.07, 0.39]. Subgroup analyses by the type of condition showed that the magnitude of effect size was the largest among patients with mental health conditions.

There is a plethora of CSRs evaluating the effectiveness of physical activity/exercise. The evidence suggests that physical activity/exercise reduces mortality rates and improves QOL with minimal or no safety concerns.

Trial registration

Registered in PROSPERO ( CRD42019120295 ) on 10th January 2019.

Peer Review reports

The World Health Organization (WHO) defines physical activity “as any bodily movement produced by skeletal muscles that requires energy expenditure” [ 1 ]. Therefore, physical activity is not only limited to sports but also includes walking, running, swimming, gymnastics, dance, ball games, and martial arts, for example. In the last years, several organizations have published or updated their guidelines on physical activity. For example, the Physical Activity Guidelines for Americans, 2nd edition, provides information and guidance on the types and amounts of physical activity that provide substantial health benefits [ 2 ]. The evidence about the health benefits of regular physical activity is well established and so are the risks of sedentary behaviour [ 2 ]. Exercise is dose dependent, meaning that people who achieve cumulative levels several times higher than the current recommended minimum level have a significant reduction in the risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events [ 3 ]. Benefits of physical activity have been reported for numerous outcomes such as mortality [ 4 , 5 ], cognitive and physical decline [ 5 , 6 , 7 ], glycaemic control [ 8 , 9 ], pain and disability [ 10 , 11 ], muscle and bone strength [ 12 ], depressive symptoms [ 13 ], and functional mobility and well-being [ 14 , 15 ]. Overall benefits of exercise apply to all bodily systems including immunological [ 16 ], musculoskeletal [ 17 ], respiratory [ 18 ], and hormonal [ 19 ]. Specifically for the cardiovascular system, exercise increases fatty acid oxidation, cardiac output, vascular smooth muscle relaxation, endothelial nitric oxide synthase expression and nitric oxide availability, improves plasma lipid profiles [ 15 ] while at the same time reducing resting heart rate and blood pressure, aortic valve calcification, and vascular resistance [ 20 ].

However, the degree of all the above-highlighted benefits vary considerably depending on individual fitness levels, types of populations, age groups and the intensity of different physical activities/exercises [ 21 ]. The majority of guidelines in different countries recommend a goal of 150 min/week of moderate-intensity aerobic physical activity (or equivalent of 75 min of vigorous-intensity) [ 22 ] with differences for cardiovascular disease [ 23 ] or obesity prevention [ 24 ] or age groups [ 25 ].

There is a plethora of systematic reviews published by the Cochrane Library critically evaluating the effectiveness of physical activity/exercise for various health outcomes. Cochrane systematic reviews (CSRs) are known to be a source of high-quality evidence. Thus, it is not only timely but relevant to evaluate the current knowledge, and determine the quality of the evidence-base, and the magnitude of the effect sizes given the negative lifestyle changes and rising physical inactivity-related burden of diseases. This overview will identify the breadth and scope to which CSRs have appraised the evidence for exercise on health outcomes; and this will help in directing future guidelines and identifying current gaps in the literature.

The objectives of this research were to a. answer the following research questions: in children, adolescents and adults (both healthy and medically compromised) what are the effects (and adverse effects) of exercise/physical activity in improving various health outcomes (e.g., pain, function, quality of life) reported in CSRs; b. estimate the magnitude of the effects by pooling the results quantitatively; c. evaluate the strength and quality of the existing evidence; and d. create recommendations for future researchers, patients, and clinicians.

Our overview was registered with PROSPERO (CRD42019120295) on 10th January 2019. The Cochrane Handbook for Systematic Reviews of interventions and Preferred Reporting Items for Overviews of Reviews were adhered to while writing and reporting this overview [ 26 , 27 ].

Search strategy and selection criteria

We followed the practical guidance for conducting overviews of reviews of health care interventions [ 28 ] and searched the Cochrane Database of Systematic Reviews (CDSR), 2019, Issue 1, on the Cochrane Library for relevant papers using the search strategy: (health) and (exercise or activity or physical). The decision to seek CSRs only was based on three main aspects. First, high quality (CSRs are considered to be the ‘gold methodological standard’) [ 29 , 30 , 31 ]. Second, data saturation (enough high-quality evidence to reach meaningful conclusions based on CSRs only). Third, including non-CSRs would have heavily increased the issue of overlapping reviews (also affecting data robustness and credibility of conclusions). One reviewer carried out the searches. The study screening and selection process were performed independently by two reviewers. We imported all identified references into reference manager software EndNote (X8). Any disagreements were resolved by discussion between the authors with third overview author acting as an arbiter, if necessary.

We included CSRs of randomised controlled trials (RCTs) involving both healthy individuals and medically compromised patients of any age and gender. Only CSRs assessing exercise or physical activity as a stand-alone intervention were included. This included interventions that could initially be taught by a professional or involve ongoing supervision (the WHO definition). Complex interventions e.g., assessing both exercise/physical activity and behavioural changes were excluded if the health effects of the interventions could not have been attributed to exercise distinctly.

Any types of controls were admissible. Reviews evaluating any type of health-related outcome measures were deemed eligible. However, we excluded protocols or/and CSRs that have been withdrawn from the Cochrane Library as well as reviews with no included studies.

Data analysis

Three authors (HM, ALN, NK) independently extracted relevant information from all the included studies using a custom-made data collection form. The methodological quality of SRs included was independently evaluated by same reviewers using the AMSTAR-2 tool [ 32 ]. Any disagreements on data extraction or CSR quality were resolved by discussion. The entire dataset was validated by three authors (PP, MS, DP) and any discrepant opinions were settled through discussions.

The results of CSRs are presented in a narrative fashion using descriptive tables. Where feasible, we presented outcome measures across CSRs. Data from the subset of homogeneous outcomes were pooled quantitatively using the approach previously described by Bellou et al. and Posadzki et al. [ 33 , 34 ]. For mortality and quality of life (QOL) outcomes, the number of participants and RCTs involved in the meta-analysis, summary effect sizes [with 95% confidence intervals (CI)] using random-effects model were calculated. For binary outcomes, we considered relative risks (RRs) as surrogate measures of the corresponding odds ratio (OR) or risk ratio/hazard ratio (HR). To stabilise the variance and normalise the distributions, we transformed RRs into their natural logarithms before pooling the data (a variation was allowed, however, it did not change interpretation of results) [ 35 ]. The standard error (SE) of the natural logarithm of RR was derived from the corresponding CIs, which was either provided in the study or calculated with standard formulas [ 36 ]. Binary outcomes reported as risk difference (RD) were also meta-analysed if two more estimates were available. For continuous outcomes, we only meta-analysed estimates that were available as standardised mean difference (SMD), and estimates reported with mean differences (MD) for QOL were presented separately in a supplementary Table  9 . To estimate the overall effect size, each study was weighted by the reciprocal of its variance. Random-effects meta-analysis, using DerSimonian and Laird method [ 37 ] was applied to individual CSR estimates to obtain a pooled summary estimate for RR or SMD. The 95% prediction interval (PI) was also calculated (where ≥3 studies were available), which further accounts for between-study heterogeneity and estimates the uncertainty around the effect that would be anticipated in a new study evaluating that same association. I -squared statistic was used to measure between study heterogeneity; and its various thresholds (small, substantial and considerable) were interpreted considering the size and direction of effects and the p -value from Cochran’s Q test ( p  < 0.1 considered as significance) [ 38 ]. Wherever possible, we calculated the median effect size (with interquartile range [IQR]) of each CSR to interpret the direction and magnitude of the effect size. Sub-group analyses are planned for type and intensity of the intervention; age group; gender; type and/or severity of the condition, risk of bias in RCTs, and the overall quality of the evidence (Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria). To assess overlap we calculated the corrected covered area (CCA) [ 39 ]. All statistical analyses were conducted on Stata statistical software version 15.2 (StataCorp LLC, College Station, Texas, USA).

The searches generated 280 potentially relevant CRSs. After removing of duplicates and screening, a total of 150 CSRs met our eligibility criteria [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 ] (Fig.  1 ). Reviews were published between September 2002 and December 2018. A total of 130 CSRs employed meta-analytic techniques and 20 did not. The total number of RCTs in the CSRs amounted to 2888; with 485,110 participants (mean = 3234, SD = 13,272). The age ranged from 3 to 87 and gender distribution was inestimable. The main characteristics of included reviews are summarised in supplementary Table  1 . Supplementary Table  2 summarises the effects of physical activity/exercise on health outcomes. Conclusions from CSRs are listed in supplementary Table  3 . Adverse effects are listed in supplementary Table  4 . Supplementary Table  5 presents summary of withdrawals/non-adherence. The methodological quality of CSRs is presented in supplementary Table  6 . Supplementary Table  7 summarises studies assessed at low risk of bias (by the authors of CSRs). GRADE-ings of the review’s main comparison are listed in supplementary Table  8 .

Study selection process

There were 54 separate populations/conditions, considerable range of interventions and comparators, co-interventions, and outcome measures. For detailed description of interventions, please refer to the supplementary tables . Most commonly measured outcomes were - function 112 (75%), QOL 83 (55%), AEs 70 (47%), pain 41 (27%), mortality 28 (19%), strength 30 (20%), costs 47 (31%), disability 14 (9%), and mental health in 35 (23%) CSRs.

There was a 13% reduction in mortality rates risk ratio (RR) 0.87 [95% CI 0.78 to 0.96]; I 2  = 26.6%, [PI 0.70, 1.07], median effect size (MES) = 0.93 [interquartile range (IQR) 0.81, 1.00]; 10 CSRs, 187 RCTs, 27,671 participants) following exercise when compared with various controls (Table 1 ). This reduction was smaller in ‘other groups’ of patients when compared to cardiovascular diseases (CVD) patients - RR 0.97 [95% CI 0.65, 1.45] versus 0.85 [0.76, 0.96] respectively. The effects of exercise were not intensity or frequency dependent. Sessions more than 3 times per week exerted a smaller reduction in mortality as compared with sessions of less than 3 times per week RR 0.87 [95% CI 0.78, 0.98] versus 0.63 [0.39, 1.00]. Subgroup analyses by risk of bias (ROB) in RCTs showed that RCTs at low ROB exerted smaller reductions in mortality when compared to RCTs at an unclear or high ROB, RR 0.90 [95% CI 0.78, 1.02] versus 0.72 [0.42, 1.22] versus 0.86 [0.69, 1.06] respectively. CSRs with moderate quality of evidence (GRADE), showed slightly smaller reductions in mortality when compared with CSRs that relied on very low to low quality evidence RR 0.88 [95% CI 0.79, 0.98] versus 0.70 [0.47, 1.04].

Exercise also showed an improvement in QOL, standardised mean difference (SMD) 0.18 [95% CI 0.08, 0.28]; I 2  = 74.3%; PI -0.18, 0.53], MES = 0.20 [IQR 0.07, 0.39]; 15 CSRs, 408 RCTs, 32,984 participants) when compared with various controls (Table 2 ). These improvements were greater observed for health related QOL when compared to overall QOL SMD 0.30 [95% CI 0.21, 0.39] vs 0.06 [− 0.08, 0.20] respectively. Again, the effects of exercise were duration and frequency dependent. For instance, sessions of more than 90 mins exerted a greater improvement in QOL as compared with sessions up to 90 min SMD 0.24 [95% CI 0.11, 0.37] versus 0.22 [− 0.30, 0.74]. Subgroup analyses by the type of condition showed that the magnitude of effect was the largest among patients with mental health conditions, followed by CVD and cancer. Physical activity exerted negative effects on QOL in patients with respiratory conditions (2 CSRs, 20 RCTs with 601 patients; SMD -0.97 [95% CI -1.43, 0.57]; I 2  = 87.8%; MES = -0.46 [IQR-0.97, 0.05]). Subgroup analyses by risk of bias (ROB) in RCTs showed that RCTs at low or unclear ROB exerted greater improvements in QOL when compared to RCTs at a high ROB SMD 0.21 [95% CI 0.10, 0.31] versus 0.17 [0.03, 0.31]. Analogically, CSRs with moderate to high quality of evidence showed slightly greater improvements in QOL when compared with CSRs that relied on very low to low quality evidence SMD 0.19 [95% CI 0.05, 0.33] versus 0.15 [− 0.02, 0.32]. Please also see supplementary Table  9 more studies reporting QOL outcomes as mean difference (not quantitatively synthesised herein).

Adverse events (AEs) were reported in 100 (66.6%) CSRs; and not reported in 50 (33.3%). The number of AEs ranged from 0 to 84 in the CSRs. The number was inestimable in 83 (55.3%) CSRs. Ten (6.6%) reported no occurrence of AEs. Mild AEs were reported in 28 (18.6%) CSRs, moderate in 9 (6%) and serious/severe in 20 (13.3%). There were 10 deaths and in majority of instances, the causality was not attributed to exercise. For this outcome, we were unable to pool the data as effect sizes were too heterogeneous (Table 3 ).

In 38 CSRs, the total number of trials reporting withdrawals/non-adherence was inestimable. There were different ways of reporting it such as adherence or attrition (high in 23.3% of CSRs) as well as various effect estimates including %, range, total numbers, MD, RD, RR, OR, mean and SD. The overall pooled estimates are reported in Table 3 .

Of all 16 domains of the AMSTAR-2 tool, 1876 (78.1%) scored ‘yes’, 76 (3.1%) ‘partial yes’; 375 (15.6%) ‘no’, and ‘not applicable’ in 25 (1%) CSRs. Ninety-six CSRs (64%) were scored as ‘no’ on reporting sources of funding for the studies followed by 88 (58.6%) failing to explain the selection of study designs for inclusion. One CSR (0.6%) each were judged as ‘no’ for reporting any potential sources of conflict of interest, including any funding for conducting the review as well for performing study selection in duplicate.

In 102 (68%) CSRs, there was predominantly a high risk of bias in RCTs. In 9 (6%) studies, this was reported as a range, e.g., low or unclear or low to high. Two CSRs used different terminology i.e., moderate methodological quality; and the risk of bias was inestimable in one CSR. Sixteen (10.6%) CSRs did not identify any studies (RCTs) at low risk of random sequence generation, 28 (18.6%) allocation concealment, 28 (18.6%) performance bias, 84 (54%) detection bias, 35 (23.3%) attrition bias, 18 (12%) reporting bias, and 29 (19.3%) other bias.

In 114 (76%) CSRs, limitation of studies was the main reason for downgrading the quality of the evidence followed by imprecision in 98 (65.3%) and inconsistency in 68 (45.3%). Publication bias was the least frequent reason for downgrading in 26 (17.3%) CSRs. Ninety-one (60.7%) CSRs reached equivocal conclusions, 49 (32.7%) reviews reached positive conclusions and 10 (6.7%) reached negative conclusions (as judged by the authors of CSRs).

In this systematic review of CSRs, we found a large body of evidence on the beneficial effects of physical activity/exercise on health outcomes in a wide range of heterogeneous populations. Our data shows a 13% reduction in mortality rates among 27,671 participants, and a small improvement in QOL and health-related QOL following various modes of physical activity/exercises. This means that both healthy individuals and medically compromised patients can significantly improve function, physical and mental health; or reduce pain and disability by exercising more [ 190 ]. In line with previous findings [ 191 , 192 , 193 , 194 ], where a dose-specific reduction in mortality has been found, our data shows a greater reduction in mortality in studies with longer follow-up (> 12 months) as compared to those with shorter follow-up (< 12 months). Interestingly, we found a consistent pattern in the findings, the higher the quality of evidence and the lower the risk of bias in primary studies, the smaller reductions in mortality. This pattern is observational in nature and cannot be over-generalised; however this might mean less certainty in the estimates measured. Furthermore, we found that the magnitude of the effect size was the largest among patients with mental health conditions. A possible mechanism of action may involve elevated levels of brain-derived neurotrophic factor or beta-endorphins [ 195 ].

We found the issue of poor reporting or underreporting of adherence/withdrawals in over a quarter of CSRs (25.3%). This is crucial both for improving the accuracy of the estimates at the RCT level as well as maintaining high levels of physical activity and associated health benefits at the population level.

Even the most promising interventions are not entirely risk-free; and some minor AEs such as post-exercise pain and soreness or discomfort related to physical activity/exercise have been reported. These were typically transient; resolved within a few days; and comparable between exercise and various control groups. However worryingly, the issue of poor reporting or underreporting of AEs has been observed in one third of the CSRs. Transparent reporting of AEs is crucial for identifying patients at risk and mitigating any potential negative or unintended consequences of the interventions.

High risk of bias of the RCTs evaluated was evident in more than two thirds of the CSRs. For example, more than half of reviews identified high risk of detection bias as a major source of bias suggesting that lack of blinding is still an issue in trials of behavioural interventions. Other shortcomings included insufficiently described randomisation and allocation concealment methods and often poor outcome reporting. This highlights the methodological challenges in RCTs of exercise and the need to counterbalance those with the underlying aim of strengthening internal and external validity of these trials.

Overall, high risk of bias in the primary trials was the main reason for downgrading the quality of the evidence using the GRADE criteria. Imprecision was frequently an issue, meaning the effective sample size was often small; studies were underpowered to detect the between-group differences. Pooling too heterogeneous results often resulted in inconsistent findings and inability to draw any meaningful conclusions. Indirectness and publication bias were lesser common reasons for downgrading. However, with regards to the latter, the generally accepted minimum number of 10 studies needed for quantitatively estimate the funnel plot asymmetry was not present in 69 (46%) CSRs.

Strengths of this research are the inclusion of large number of ‘gold standard’ systematic reviews, robust screening, data extractions and critical methodological appraisal. Nevertheless, some weaknesses need to be highlighted when interpreting findings of this overview. For instance, some of these CSRs analysed the same primary studies (RCTs) but, arrived at slightly different conclusions. Using, the Pieper et al. [ 39 ] formula, the amount of overlap ranged from 0.01% for AEs to 0.2% for adherence, which indicates slight overlap. All CSRs are vulnerable to publication bias [ 196 ] - hence the conclusions generated by them may be false-positive. Also, exercise was sometimes part of a complex intervention; and the effects of physical activity could not be distinguished from co-interventions. Often there were confounding effects of diet, educational, behavioural or lifestyle interventions; selection, and measurement bias were inevitably inherited in this overview too. Also, including CSRs only might lead to selection bias; and excluding reviews published before 2000 might limit the overall completeness and applicability of the evidence. A future update should consider these limitations, and in particular also including non-CSRs.

Conclusions

Trialists must improve the quality of primary studies. At the same time, strict compliance with the reporting standards should be enforced. Authors of CSRs should better explain eligibility criteria and report sources of funding for the primary studies. There are still insufficient physical activity trends worldwide amongst all age groups; and scalable interventions aimed at increasing physical activity levels should be prioritized [ 197 ]. Hence, policymakers and practitioners need to design and implement comprehensive and coordinated strategies aimed at targeting physical activity programs/interventions, health promotion and disease prevention campaigns at local, regional, national, and international levels [ 198 ].

Availability of data and materials

Data sharing is not applicable to this article as no raw data were analysed during the current study. All information in this article is based on published systematic reviews.

Abbreviations

Adverse events

Cardiovascular diseases

Cochrane Database of Systematic Reviews

Cochrane systematic reviews

Confidence interval

Grading of Recommendations Assessment, Development and Evaluation

Hazard ratio

Interquartile range

Mean difference

Prediction interval

Quality of life

Randomised controlled trials

Relative risk

Risk difference

Risk of bias

Standard error

Standardised mean difference

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PP wrote the protocol, ran the searches, validated, analysed and synthesised data, wrote and revised the drafts. HM, NK and ALN screened and extracted data. MS and DP validated and analysed the data. RB ran statistical analyses. All authors contributed to writing and reviewing the manuscript. PP is the guarantor. The authors read and approved the final manuscript.

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Supplementary Information

Additional file 1:.

Supplementary Table 1. Main characteristics of included Cochrane systematic reviews evaluating the effects of physical activity/exercise on health outcomes ( n  = 150). Supplementary Table 2. Additional information from Cochrane systematic reviews of the effects of physical activity/exercise on health outcomes ( n  = 150). Supplementary Table 3. Conclusions from Cochrane systematic reviews “quote”. Supplementary Table 4 . AEs reported in Cochrane systematic reviews. Supplementary Table 5. Summary of withdrawals/non-adherence. Supplementary Table 6. Methodological quality assessment of the included Cochrane reviews with AMSTAR-2. Supplementary Table 7. Number of studies assessed as low risk of bias per domain. Supplementary Table 8. GRADE for the review’s main comparison. Supplementary Table 9. Studies reporting quality of life outcomes as mean difference.

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Posadzki, P., Pieper, D., Bajpai, R. et al. Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews. BMC Public Health 20 , 1724 (2020). https://doi.org/10.1186/s12889-020-09855-3

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DOI : https://doi.org/10.1186/s12889-020-09855-3

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What to know about exercise and how to start

Exercise involves engaging in physical activity and increasing the heart rate beyond resting levels. It is an important part of preserving physical and mental health.

Whether people engage in light exercise, such as going for a walk, or high intensity activities, for example, uphill cycling or weight training, regular exercise provides a huge range of benefits for the body and mind.

Taking part in exercise of any intensity every day is essential for preventing a range of diseases and other health issues.

In this article, we explain the different types of exercise and their benefits, as well as the considerations for designing a fitness regime.

Types and benefits

People divide exercise into three broad categories:

• agility training

We describe each of these categories below.

Aerobic exercise

Aerobic exercise aims to improve how the body uses oxygen. Most aerobic exercise takes place at average levels of intensity over longer periods.

An aerobic exercise session involves warming up, exercising for at least 20 minutes, and then cooling down. Aerobic exercise mostly uses large muscle groups.

Aerobic exercise provides the following benefits:

• improves muscle strength in the lungs, heart, and whole body
• lowers blood pressure
• improves circulation and blood flow in the muscles
• increases the red blood cell count to enhance oxygen transportation
• reduces the risk of diabetes , stroke , and cardiovascular disease (CVD)
• improves life expectancy and symptoms for people with coronary artery diseases
• stimulates bone growth and reduces the risk of osteoporosis when at high intensity
• improves sleep hygiene
• enhances stamina by increasing the body’s ability to store energy molecules, such as fats and carbohydrates , within muscle

Anaerobic exercise

Anaerobic exercise does not use oxygen for energy. People use this type of exercise to build power, strength, and muscle mass.

These exercises are high-intensity activities that should last no longer than around 2 minutes. Anaerobic exercises include:

• weightlifting
• intensive and fast skipping with a rope
• interval training
• any rapid burst of intense activity

While all exercise benefits the heart and lungs, anaerobic exercise provides fewer benefits for cardiovascular health than aerobic exercise and uses fewer calories . However, it is more effective than aerobic exercise for building muscle and improving strength.

Increasing muscle mass causes the body to burn more fat, even when resting. Muscle is the most efficient tissue for burning fat in the body.

Agility training

Agility training aims to improve a person’s ability to maintain control while speeding up, slowing down, and changing direction.

In tennis, for example, agility training helps a player maintain control over their court positioning through good recovery after each shot.

People who take part in sports that heavily rely on positioning, coordination, speed, and balance need to engage in agility training regularly.

The following sports are examples of ones that require agility:

• American football
• martial arts

Stretching and flexibility

Some exercises combine stretching, muscle conditioning, and balance training. A popular and effective example is yoga .

Yoga movements improve balance, flexibility, posture, and circulation.

The practice originated in India thousands of years ago and aims to unify the mind, body, and spirit. Modern yoga uses a combination of meditation, posture, and breathing exercises to achieve the same goals.

A yoga practitioner can tailor a course for individual needs.

A person looking to manage arthritis might need gentle stretches to improve mobility and function. Someone with depression , on the other hand, may need more emphasis on the relaxation and deep breathing elements of yoga.

Pilates is another stretching option that promotes flexibility and core strength. Tai chi is also an effective option for exercise that promotes calm stretching rather than intensity.

Here, learn more about yoga.

Risks of not exercising

A sedentary lifestyle can increase the risk of the following health problems:

• cardiovascular disease
• type 2 diabetes
• osteoporosis

It can also contribute to an increased risk of premature death from all causes, including the complications of being overweight and obesity .

In many parts of the world, including the United States, the number of overweight and obese people continues to increase rapidly.

According to the most recent National Health and Nutrition Examination Survey , that researchers did in 2013–2014 across the U.S., more than 2 in 3 adults are overweight or obesity.

The same survey found that around 1 in 13 adults have extreme obesity and face an increased risk of severe health complications.

Discover how to prevent cardiovascular disease.

Finding time to exercise

Fitting exercise into a busy schedule can be a roadblock to a successful regime. However, people do not need to dedicate large amounts of extra time to exercise to see the benefits.

Here are some tips for fitting physical activity in a busy schedule:

• See which car journeys you can replace with walking or cycling. Is driving to work necessary? If so, try parking half a mile away from the office and walking the final bit.
• People who commute to work by public transport could try getting off their bus or train a few stops early and walking the rest of the way.
• Consider walking up and down the stairs at your office instead of taking elevators or escalators.
• Try to think about the amount of time spent watching television and avoid binge-watching TV shows. While watching television for extended periods, light exercises, such as stomach crunches or jumping jacks, can help a person include more physical activity in their day.
• If a person enjoys video games, they could consider playing games that encourage physical activity, such as exercise routines on a Nintendo Wii.
• Vigorous housework, gardening, and going up and down the stairs while doing chores also qualify as physical activity and can help people meet the guidelines productively.

People will likely gain the most benefit from exercises they enjoy that fit their lifestyle.

• Some of the examples below are the easiest to fit into a daily routine:
• Go for a brisk 30-minute walk five times every week.
• Walk your dog more often or go for walks and jogs with friends.
• Try to add swimming to your weekly routine, even if it is not every day.
• Join some exercise classes that are fun, collaborative, and educational.
• Become a member of a martial arts club. Beginner’s sessions can be gentle and fun.

Exercise is sometimes a gradual learning curve. A person should spread sessions across the week and scale up the intensity slowly.

It is important for people to ensure they drink plenty of water during and after exercise. Checking with a doctor is a good precaution to take if someone has a health condition or injury that could impact exercise levels, or that exercise could make worse.

While a combination of aerobic and anaerobic exercise provides the most benefit, any exercise is better than none for people who currently have an inactive lifestyle.

Current U.S. guidelines recommend that people do one of the following:

• at least 150–300 minutes of moderate-intensity exercise a week
• a minimum of 75–150 minutes of vigorous-intensity, aerobic physical activity
• a combination of the two types of exercise

Toward these goals, it is worth remembering that even 10-minute bursts of physical activity during the day provide health benefits.

Please note: Medical News Today does not imply a warranty of fitness for a particular purpose or endorse any of these applications. Nobody at MNT has evaluated them for medical accuracy. The Food and Drug Administration (FDA) has not approved them unless otherwise indicated.

Tips for starting

Exercise may be difficult to maintain for some people. Consider the following tips to achieve long-term success:

• Have a clear goal: Whether for health reasons or otherwise, try to always keep in mind the reason you started increasing your exercise levels.
• Work at your own pace: Doing too much too quickly can increase the risk of injury and the chance to develop a stable routine. Set targets based on the goals you established at the start of the regimen and celebrate small wins to boost confidence.
• Enjoy yourself: A regimen is more sustainable if a person enjoys the physical activities that it involves.
• Join a club with a friend: If you join a fitness club with a friend, or exercise with a friend, you may enjoy the sessions more. Some people prefer not to have the stress of someone else around. This depends on you.
• Trainers and teachers can be helpful: People just starting a regimen or looking to step up their routine may benefit from a personal trainer or teacher. They can provide motivation and guidance, helping people track their goals and stay dedicated.
• Vary your exercises: Change your exercise program every few weeks. Mixing it up can help a person work on different muscle groups and increase the range of benefits. If you enjoy one particular exercise, such as running, try changing the speed and distance of a run, or follow a different route with more hills.
• Make it a habit: After a few weeks of regularity, an exercise routine starts to become a habit, even if you find it difficult or boring at first.

The benefits of regular physical activity are wide-reaching and should form a part of every person’s day to help them remain healthy.

I have a prohibitive physical impediment that prevents me from exercising in the standard way. What is the best course of action for getting started?

It depends on what type of impediment it is. I would encourage you to obtain medical clearance first from your primary healthcare provider, and then seek the services of a Certified Personal Trainer, especially if you have never exercised before.

Without knowledge of how to properly execute various exercises, a person can cause further injury to themselves.

Also, proper use of exercise, depending on the type of physical impediment, can possibly help improve this situation.

Daniel Bubnis, MS, NASM-CPT, NASE Level II-CSS Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Last medically reviewed on June 27, 2019

• Obesity / Weight Loss / Fitness
• Sports Medicine / Fitness

How we reviewed this article:

• Booth, F. W., et al. (2014). Lack of exercise is a major cause of chronic diseases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241367/
• Executive summary: Physical activity guidelines for Americans 2nd edition. (n.d.).  https://health.gov/paguidelines/second-edition/pdf/PAG_ExecutiveSummary.pdf
• Get fit for free. (2017). http://www.nhs.uk/livewell/fitness/Pages/Fitnesshome.aspx
• Overweight and obesity statistics. (2017).  https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity
• Physical activity basics. (2019).  https://www.cdc.gov/physicalactivity/basics/index.htm
• Winzer, E. B., et al. (2018). Physical activity in the prevention and treatment of coronary artery disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850195/

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How Exercise Strengthens Your Brain

Physical activity improves cognitive and mental health in all sorts of ways. Here’s why, and how to reap the benefits.

By Dana G. Smith

Growing up in the Netherlands, Henriette van Praag had always been active, playing sports and riding her bike to school every day. Then, in the late-1990s, while working as a staff scientist at the Salk Institute for Biological Studies in San Diego, she discovered that exercise can spur the growth of new brain cells in mature mice. After that, her approach to exercise changed.

“I started to take it more seriously,” said Dr. van Praag, now an associate professor of biomedical science at Florida Atlantic University. Today, that involves doing CrossFit and running five or six miles several days a week.

Whether exercise can cause new neurons to grow in adult humans — a feat previously thought impossible, and a tantalizing prospect to treat neurodegenerative diseases — is still up for debate . But even if it’s not possible, physical activity is excellent for your brain, improving mood and cognition through “a plethora” of cellular changes, Dr. van Praag said.

What are some of the benefits, specifically?

Exercise offers short-term boosts in cognition. Studies show that immediately after a bout of physical activity, people perform better on tests of working memory and other executive functions . This may be in part because movement increases the release of neurotransmitters in the brain, most notably epinephrine and norepinephrine.

“These kinds of molecules are needed for paying attention to information,” said Marc Roig, an associate professor in the School of Physical and Occupational Therapy at McGill University. Attention is essential for working memory and executive functioning, he added.

The neurotransmitters dopamine and serotonin are also released with exercise, which is thought to be a main reason people often feel so good after going for a run or a long bike ride.

The brain benefits really start to emerge, though, when we work out consistently over time. Studies show that people who work out several times a week have higher cognitive test scores, on average, than people who are more sedentary. Other research has found that a person’s cognition tends to improve after participating in a new aerobic exercise program for several months.

Dr. Roig added the caveat that the effects on cognition aren’t huge, and not everyone improves to the same degree. “You cannot acquire a super memory just because you exercised,” he said.

Physical activity also benefits mood . People who work out regularly report having better mental health than people who are sedentary. And exercise programs can be effective at treating people’s depression, leading some psychiatrists and therapists to prescribe physical activity. The Centers for Disease Control and Prevention’s recommendation of 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity per week is a good benchmark.

Perhaps most remarkable, exercise offers protection against neurodegenerative diseases. “Physical activity is one of the health behaviors that’s shown to be the most beneficial for cognitive function and reducing risk of Alzheimer’s and dementia,” said Michelle Voss, an associate professor of psychological and brain sciences at the University of Iowa.

How does exercise do all that?

It starts with the muscles. When we work out, they release molecules that travel through the blood up to the brain. Some, like a hormone called irisin, have “neuroprotective” qualities and have been shown to be linked to the cognitive health benefits of exercise, said Christiane Wrann, an associate professor of medicine at Massachusetts General Hospital and Harvard Medical School who studies irisin . (Dr. Wrann is also a consultant for a pharmaceutical company, Aevum Therapeutics, hoping to harness irisin’s effects into a drug.)

Good blood flow is essential to obtain the benefits of physical activity. And conveniently, exercise improves circulation and stimulates the growth of new blood vessels in the brain. “It’s not just that there’s increased blood flow,” Dr. Voss said. “It’s that there’s a greater chance, then, for signaling molecules that are coming from the muscle to get delivered to the brain.”

Once these signals are in the brain, other chemicals are released locally. The star of the show is a hormone called brain-derived neurotrophic factor, or B.D.N.F., that is essential for neuron health and creating new connections — called synapses — between neurons. “It’s like a fertilizer for brain cells to recover from damage,” Dr. Voss said. “And also for synapses on nerve cells to connect with each other and sustain those connections.”

A greater number of blood vessels and connections between neurons can actually increase the size of different brain areas. This effect is especially noticeable in older adults because it can offset the loss of brain volume that happens with age. The hippocampus, an area important for memory and mood, is particularly affected. “We know that it shrinks with age,” Dr. Roig said. “And we know that if we exercise regularly, we can prevent this decline.”

Exercise’s effect on the hippocampus may be one way it helps protect against Alzheimer’s disease, which is associated with significant changes to that part of the brain. The same goes for depression; the hippocampus is smaller in people who are depressed, and effective treatments for depression , including medications and exercise, increase the size of the region.

What kind of exercise is best for your brain?

The experts emphasized that any exercise is good, and the type of activity doesn’t seem to matter, though most of the research has involved aerobic exercise. But, they added, higher-intensity workouts do appear to confer a bigger benefit for the brain.

Improving your overall cardiovascular fitness level also appears to be key. “It’s dose-dependent,” Dr. Wrann said. “The more you can improve your cardiorespiratory fitness, the better the benefits are.”

Like Dr. van Praag, Dr. Voss has incorporated her research into her life, making a concerted effort to engage in higher intensity exercise. For example, on busy days when she can’t fit in a full workout, she’ll seek out hills to bike up on her commute to work. “Even if it’s a little,” she said, “it’s still better than nothing.”

Dana G. Smith is a Times reporter covering personal health, particularly aging and brain health. More about Dana G. Smith

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Benefits Of Aerobics Report

Aerobics is a type of physical exercise that involves rhythmic movements with stretching and strength-training routines aimed at improving all the aspects of fitness that include flexibility, muscular strength, and cardiovascular fitness. It is mainly carried out in a group setting, at the directions of an instructor, with background music. Nevertheless, individual performance with or without the accompaniment of music is often undertaken. Ideally, aerobics exercises performance is for at least 30 minutes a day, 20 minutes of which are used to make a performance at a taxing degree of intensity. Participants in the exercise perform various routines comprising of diverse dance-like exercises. Official classes of aerobics are designated into different levels depending on the fitness level of the participants. These exercises are energetic, vigorous, regular, and last long enough to offer essential health benefits to the body (“What is aerobic?” para 1).

The benefits of aerobic exercise are best realized by increasing the heart rate and practicing hard breathing for a prolonged period. For the period of the exercise, the body gives out more energy and transports more oxygen to the muscles. The heartbeat increases and fastens the flow of blood to the muscles and back to the lungs. This builds up the heart, improves its strength to pump blood more proficiently, and increases the rate of circulation of blood throughout the body.

Aerobic fitness is a vital asset in emergency crises such as earthquakes, floods, loss in the wilderness, and other bizarre situations. The capability of one to move out safely or to endure such conditions depends on one’s ability to walk, run, swim, climb, and carry out other activities (“Aerobic Fitness Information”).

Aerobic fitness is associated with the health of individuals. In the United States alone, more than 800,000 citizens die every year from heart-related complications (“Aerobic Fitness Information” para.1). These heart diseases are the number one cause of death in the United States. The risk factors for these complications include inactivity, high levels of cholesterol, excessive smoking, high blood pressure, and diabetes. Study after study has proved that inactivity is the predominant factor responsible for heart diseases. It is two times as crucial as high levels of cholesterol and four times more crucial than high blood pressure. Therefore, aerobic exercise lowers the risk of death due to heart attack and it is a proven method of rehabilitating individuals suffering from a heart attack.

Aerobic exercises play a role in conditioning the cardiovascular system that is composed of heat and the lungs. They increase the level of oxygen present in the body and enable the heart to utilize oxygen more efficiently. It improves aerobic endurance, muscular endurance, and an individual’s exercise capacity. These cardiovascular activities when done routinely assist in diminishing the onset of heart diseases (“Stop aging-Start Training” para.2).

It has been demonstrated through studies that cholesterol, triglycerides, and blood pressure levels can all be significantly lowered by undertaking regular cardiovascular conditioning. Reduction in high blood pressure levels has been reported even in people who already have been diagnosed as suffering from hypertension. One study particularly proved that the arteries lining (endothelium) in individuals who are aerobically active remained flexible, better able to grow and expand, and demonstrated an increased efficiency in the passage of blood platelets. Loss of this flexibility of artery lining often results in atherosclerosis and another type of heart disease (“Stop aging-Start Training” para.3).

Aerobic exercise is a vital factor during the growth and development of children and teenagers. It is also of the essence in the process of aging. The practice of aerobic fitness at the stages of active growth is an indication of a good development of the muscles, bones, and cardiovascular system. At old age, aerobic exercise is a fundamental evaluation of one’s physiological fitness. A 60-year-old person with elevated aerobic fitness may be perceived that he or is 15-20 years younger with respect to the situation of that individual’s different body systems. Moreover, they tend to have an increased life span. (“Aerobic fitness information”)

Aerobics fitness measures the capacity of one to maintain prolonged efforts, it establishes the level of fatigue that everyone gets along with in daily life. An aerobically fit person is capable of withstanding stress due to two uncommon environmental conditions: extreme heat, and high altitude. Persons who have undergone aerobic training are able to exercise much longer than untrained individuals are. These exercises boost the mood of an individual as they relieve the gloominess of depression, ease the tension linked with anxiety, and improve the relaxation of persons.

In order for weight to be lost, a calorie deficit must be created that increases the rate of burning of calories to exceed the quantities taken in. Engaging in activities that burn up high quantities of calories is an excellent way to undertake a calorie-controlled diet to assist in getting rid of the unwanted pounds in the body. As an example, 30 minutes of low-paced jogging utilizes about 300 calories of energy. This is possible of making a significant input towards realizing the essential calorie deficit for weight loss, or on the other hand, it can give one a bar of chocolate that one may feel less guilty about having a meal. Aerobic fitness is one of the best solutions when an individual wants to manage his or her weight. These exercises control the levels of blood sugar and increase the body’s metabolic rate hence is fundamental in burning more calories together with an improvement in the levels of energy of the individual.

Aerobic exercises are economical to perform. People do not need to deprive themselves of their last coins in their wallets since activities like walking, running, and many others are easy and involve fun to perform. Moreover, the body’s immune system increases on the undertaking of these activities. Unwanted diseases are eliminated from the body and significantly lower the problems associated with flu and colds alongside other health-related complications like diabetes, obesity, certain types of cancer, osteoporosis, and diseases of the heart. These activities improve the quality of sleep and refresh an individual’s next morning.

The superb medicine constantly tastes bitter. This can be illustrated by the example of aerobic fitness, which most of the time is underrated among the options when individuals are advised to carry them out to improve their health. How many people are aware that performing aerobic exercises is one of the proven best ways of maintaining a good healthy life? After the performance, one feels better about herself or himself and there is no one side effect associated with it. Aerobics fitness has many potential benefits that everyone should embrace in keeping the doctor away.

Works Cited

Aerobic Fitness Information. Universal fitness Tester. 1999. Web.

“Stop aging-Start Training.” Chera Wellness. 2009. Web.

“What is aerobic?” Aerobic.org. 2009. Web.

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• Exercise & Fitness

Why Walking Isn’t Enough When It Comes to Exercise

W alking is often thought of as a mere mode of transportation: a way to get from point A to point B. Few of us consider the fact that it’s one of the most fundamental, accessible physical activities a person can do.

What’s so great about walking? 

Walking might not be as impressive as holding a plank or doing mountain climbers, but “it’s considered a bodyweight exercise, because your large muscle groups are working to move the weight of your body,” says Dr. Marie Kanagie-McAleese, a pediatric hospitalist at University of Maryland Upper Chesapeake Health and the leader of the Bel Air, Md. chapter of Walk With a Doc .

As you walk, “your quadriceps, hamstrings, calves—even your abdominals, biceps, and shoulders—are all using oxygen to contract,” says Ali Ball, an exercise physiologist and outpatient cardiac rehab/wellness coordinator at OSF HealthCare in Urbana, Ill. That also makes walking a form of aerobic exercise, she adds, which means it keeps your heart rate elevated for a sustained amount of time. One study published in the Journal of the American College of Cardiology found that 15 minutes of walking was as beneficial as five minutes of running.

From a physiological perspective, that’s a one-two punch of health benefits.

“First, walking improves the health of our cardiovascular system,” says McAleese. “With improved oxygen delivery to our organs, we see a decrease in the risk of heart disease, stroke, obesity, metabolic syndrome, diabetes, high blood pressure, and high cholesterol.” 

Read More : Your Brain Doesn't Want You to Exercise

Research bears this out. In a 2021 study published in JAMA Network Open , people who logged at least 7,000 steps per day had a 50 to 70%lower risk of early death, compared to those who walked less than 7,000 steps per day. Meanwhile, a 2023 meta-analysis published in the British Journal of Sports Medicine concluded that doing moderate-intensity physical activity—like brisk walking—for just 11 minutes a day is enough to lower the risk of diseases such as heart disease, stroke, and a number of cancers.

Plus, it’s the easiest way to counter the risk of a sedentary lifestyle, says McAleese. “Walking more throughout the entire day, even if you’re not doing it at a moderate-intensity level, is critically important,” since sitting too much increases the risk of getting—and dying from—many chronic diseases.

But is just walking enough exercise? 

It can’t do everything. Federal physical-activity guidelines recommend at least 150 minutes of aerobic physical activity a week, plus two or more sessions of muscle-strengthening activities involving all major muscle groups per week. Both types of physical activity have to be of at least moderate intensity. 

With a few tweaks, your walk can fulfill the first aerobic category. “Most people just don’t do it hard enough because they don’t think about it as exercise,” says Ball. If you’re used to a casual stroll, it’s easy to increase your intensity and get into that moderate range: You can increase the pace, walk on an incline, walk on a different terrain, or add weight via a vest or pack.

Read More : Forget 10,000 Steps. Here’s How Much Science Says You Actually Need to Walk

Not so much for the second category. “Walking does provide a low level of bodyweight exercise, but there are a lot of other muscle groups that we’re not really exercising when walking,” says McAleese. Strength training comes with a lot of additional health benefits , like lowering your risk of injury and improving mobility and flexibility .

How to make your walk count as a workout 

Wearable devices have made mainstream the idea that everyone needs to hit 10,000 steps per day, but “that’s an arbitrary number not based in science ,” says McAleese. A more important metric than steps, she says, is time. When it comes to the recommended 150 weekly minutes of moderate-intensity physical activity, “you can break that up however works for you,” she explains. “If you can only fit in 10 minutes here and 10 minutes there, it all counts .”

For walking to really qualify as “moderate-intensity” exercise, you need to be moving a little more intentionally than you would during a casual stroll from one meeting to the next. The guidelines consider walking briskly—where you could walk a mile in 15 to 24 minutes—to be moderate-intensity physical activity. That’s a purposeful, I-have-somewhere-to-be pace.

The best way to tell if you’re in that moderate-intensity range is the talk test. “If you’re able to speak in complete sentences and can carry on a conversation—but if you were to try to sing, you would become out of breath—that counts as moderate-intensity aerobic exercise,” says McAleese.

Read More : I Used ChatGPT as My Personal Trainer. It Didn’t Go Well

You can also check your heart rate. An approximate (but easy-to-remember) way to find your maximum heart rate is to subtract your age from the number 220, says Ball. During moderate-intensity exercise, your heart rate should be at about 50 to 70% of that maximum heart rate, according to the American Heart Association .

And to make sure you're getting the most out of this type of physical activity, you also need to think about your form. (Yes, there’s proper form for walking.) “Focus on staying upright and keeping your abdominals engaged,” says Ball. Squeeze your butt, and let your arms swing naturally rather than exaggeratedly pumping them. Leaning forward, especially if you increase your intensity, can cause back pain.

For many people, embracing walking as exercise might just require a slight shift in perspective. “We focus a lot on scheduling exercise as a very specific activity that happens at a certain place at a certain time during our day,” says McAleese. “But we really should be expanding our definition of exercise to include all levels and amounts of physical activity that we perform throughout the entire day.” 

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Women may gain health benefits of exercise more efficiently than men

S cience is clear: We all need to move our bodies to improve our health. But a new study finds women can move less than men to live longer.

"Women get more out of every minute of physical activity than men," said Dr. Martha Gulati, the director of preventive cardiology at Cedars-Sinai Medical Center in Los Angeles.

The study from the Smidt Heart Institute at Cedars-Sinai analyzed health data from the  National Institutes of Health  for more than 400,000 adults over two decades.

Researchers found physically active women were 24% less likely to die early compared to women who didn't exercise, while men were 15% less likely. Women also had a "36% reduced risk for a fatal heart attack, stroke or other cardiovascular event — while men had a 14% reduced risk."

Dr. Gulati, who co-authored the study, says women's physiology means they can exercise less often than men while better improving their heart health.

"Women actually have more blood flow to their muscles," said Dr. Gulati, adding that "perhaps by doing smaller amounts of activity, that entire vascular response may ultimately translate into improved cardiac function."

According to the study, men need about five hours  per week of moderate to vigorous aerobic exercise, like brisk walking or cycling, to maximize their longevity.

But women get the same benefits exercising just 2.5 hours per week.

"Men getting 300 minutes a week was equivalent to a woman getting 140 minutes per week," said Gulati.

The research team studied moderate to vigorous aerobic physical activity, from cycling to weightlifting and calisthenics, but didn't look at regular daily movement, like walking or gardening. Dr. Gulati says those activities also have long-term perks, and she hopes the study leads to better national exercise guidelines for men and women.

 "Hopefully that will translate into reducing cardiac events as well as living longer, healthier lives," she said.

The current  physical activity guidelines  for Americans from the Office of Disease Prevention and Health Promotion say adults, both men and women, need 150 minutes of moderate-intensity physical activity per week along with 2 days of muscle-strengthening exercises to maintain or improve their health.

SEE MORE: These exercises may do a better job treating depression than medicine

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.

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• Muscle Gain

What makes Anaerobic Exercise good for your health?

Anaerobic exercise involves strong and powerful movements for which the body does not rely on oxygen. That is what makes it different from aerobic exercise. Anaerobic exercise can be done for just a few seconds at a time. It requires the body to go all out, and that is why doing anaerobic exercise is good for your health. Improved muscle strength is one of the main health benefits of anaerobic exercise. We tell you more about anaerobic exercise with examples.

What is anaerobic exercise?

It is an intense physical activity where oxygen demand surpasses supply, relying on stored energy sources like glycogen for short bursts of power, explains fitness expert Gaurav Molri . Examples of anaerobic exercise

1. High-Intensity Interval Training (HIIT)

HIIT is all about short and intense bursts of exercise followed by brief recovery periods. Start with a warm-up, followed by cycles of high-intensity exercises like sprints and jumping jacks for 20 to 30 seconds followed by 10 to 20 seconds of rest.

2. Strength training

It utilises resistance, like weights or bodyweight, to build strength and muscle mass. Begin with compound exercises such as squats and deadlifts, ensuring proper form and gradually increasing weight.

3. Plyometrics

Plyometrics are explosive movements like jump squats or box jumps to develop power. Do jumps or bounds while focusing on quality over quantity to prevent injury, suggests the expert.

4. Sprinting

Sprinting is all about short, maximum-effort runs. Warm up thoroughly then sprint at maximum effort for short distances, gradually increasing speed and distance.

5. Calisthenics

Calisthenics are bodyweight exercises like push-ups, pull-ups, and squats. Include a mix of these exercises targeting different muscle groups, adjusting intensity and difficulty as needed.

What is the difference between anaerobic exercise and aerobic exercise?

They key differences between anaerobic exercise and aerobic exercise lie in t he way the body uses stored energy, and the intensity and duration of the exercise you do.

Anaerobic exercises are high-intensity, short-duration activities that primarily use glycogen, which is a form of glucose, for energy. Aerobic exercises , on the other hand, are moderate-intensity activities that rely on oxygen for energy production, says Molri. Aerobic exercises such as swimming, cycling and dancing, can be done for a long duration unlike anaerobic exercises.

What are the health benefits of anaerobic exercise?

Like aerobic exercise, anaerobic exercise also has a positive correlation towards improved cardiovascular health, according to a 2017 study published in the World Journal of Cardiology . Here are some more benefits:

Keep an idea of your risk of weight-related issues.

• Builds muscle strength and mass.
• Boosts metabolism for calorie burn.
• Enhances bone density.
• Increases overall functional fitness.
• Decreases high blood pressure.
• Improves mood.
• Decreases your risk of developing health conditions like heart disease.

Can you burn fat by doing anaerobic exercise?

Anaerobic exercise is mostly associated with muscle strength and power, but it is also good for burning fat. Anaerobic exercise, particularly high-intensity forms like HIIT and weightlifting, can contribute to fat loss. Anaerobic exercise helps increase metabolism, build lean muscle mass, and improve overall body composition, leading to greater fat burning even after the workout is over, says the expert. The intense nature of anaerobic exercise can lead to an “afterburn” effect, where the body continues to burn calories at an elevated rate post-workout, further aiding in fat loss.

But people with certain health conditions such as respiratory problems or joint injuries should consult with a doctor or fitness expert before starting anaerobic exercise. Even pregnant women need to be cautious when it comes to anaerobic exercise.

Natalia Ningthoujam has written on various subjects - from music to films and fashion to lifestyle - as a journalist in her career that started in 2010. After getting stories from the crime scene, police headquarters, and conducting interviews with celebrities, she is now writing on health and wellness which has become her focus area. ... Read More

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Role of Physical Activity on Mental Health and Well-Being: A Review

Aditya mahindru.

1 Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND

Pradeep Patil

Varun agrawal.

In addition to the apparent physical health benefits, physical activity also affects mental health positively. Physically inactive individuals have been reported to have higher rates of morbidity and healthcare expenditures. Commonly, exercise therapy is recommended to combat these challenges and preserve mental wellness. According to empirical investigations, physical activity is positively associated with certain mental health traits. In nonclinical investigations, the most significant effects of physical exercise have been on self-concept and body image. An attempt to review the current understanding of the physiological and psychological mechanisms by which exercise improves mental health is presented in this review article. Regular physical activity improves the functioning of the hypothalamus-pituitary-adrenal axis. Depression and anxiety appear to be influenced by physical exercise, but to a smaller extent in the population than in clinical patients. Numerous hypotheses attempt to explain the connection between physical fitness and mental wellness. Physical activity was shown to help with sleep and improve various psychiatric disorders. Exercise in general is associated with a better mood and improved quality of life. Physical exercise and yoga may help in the management of cravings for substances, especially in people who may not have access to other forms of therapy. Evidence suggests that increased physical activity can help attenuate some psychotic symptoms and treat medical comorbidities that accompany psychotic disorders. The dearth of literature in the Indian context also indicated that more research was needed to evaluate and implement interventions for physical activity tailored to the Indian context.

Introduction and background

Physical activity has its origins in ancient history. It is thought that the Indus Valley civilization created the foundation of modern yoga in approximately 3000 B.C. during the early Bronze Age [ 1 ]. The beneficial role of physical activity in healthy living and preventing and managing health disorders is well documented in the literature. Physical activity provides various significant health benefits. Mechanical stress and repeated exposure to gravitational forces created by frequent physical exercise increase a variety of characteristics, including physical strength, endurance, bone mineral density, and neuromusculoskeletal fitness, all of which contribute to a functional and independent existence. Exercise, defined as planned, systematic, and repetitive physical activity, enhances athletic performance by improving body composition, fitness, and motor abilities [ 2 ]. The function of physical activity in preventing a wide range of chronic illnesses and premature mortality has been extensively examined and studied. Adequate evidence links medical conditions such as cardiovascular disease and individual lifestyle behaviours, particularly exercise [ 3 ]. Regular exercise lowered the incidence of cardiometabolic illness, breast and colon cancer, and osteoporosis [ 4 ]. In addition to improving the quality of life for those with nonpsychiatric diseases such as peripheral artery occlusive disease and fibromyalgia, regular physical activity may help alleviate the discomforts of these particular diseases [ 5 ]. Exercise also helps with various substance use disorders, such as reducing or quitting smoking. As physical exercise strongly impacts health, worldwide standards prescribe a weekly allowance of "150 minutes" of modest to vigorous physical exercise in clinical and non-clinical populations [ 6 ]. When these recommendations are followed, many chronic diseases can be reduced by 20%-30%. Furthermore, thorough evaluations of global studies have discovered that a small amount of physical exercise is sufficient to provide health benefits [ 7 ].

Methodology

In this review article, a current understanding of the underlying physiological and psychological processes during exercise or physical activity that are implicated in improving mental health is presented. Search terms like "exercise" or "physical activity" and "mental health", "exercise" or "physical activity" and "depression", "exercise" or "physical activity" and "stress", "exercise" or "physical activity" and "anxiety", "exercise" or "physical activity" and "psychosis," "exercise" or "physical activity" and "addiction" were used as search terms in PubMed, Google Scholar, and Medline. An overwhelming majority of references come from works published within the past decade.

The impact of physical health on mental health

There is an increasing amount of evidence documenting the beneficial impacts of physical activity on mental health, with studies examining the effects of both brief bouts of exercise and more extended periods of activity. Systematic evaluations have indicated better outcomes for mental diseases with physical activity. Numerous psychological effects, such as self-esteem, cognitive function, mood, depression, and quality of life, have been studied [ 8 ]. According to general results, exercise enhances mood and self-esteem while decreasing stress tendencies, a factor known to aggravate mental and physical diseases [ 9 ]. Studies show that people who exercise regularly have a better frame of mind. However, it should be highlighted that a consistent link between mood enhancement and exercise in healthy individuals has not been established.

Additionally, human beings produce more of these two neurochemicals when they engage in physical activity. Human bodies manufacture opioids and endocannabinoids that are linked to pleasure, anxiolytic effects, sleepiness, and reduced pain sensitivity [ 10 ]. It has been shown that exercise can improve attention, focus, memory, cognition, language fluency, and decision-making for up to two hours [ 11 ]. Researchers state that regular physical activity improves the functioning of the hypothalamus-pituitary-adrenal (HPA) axis, lowering cortisol secretion and restoring the balance of leptin and ghrelin (Figure ​ (Figure1) 1 ) [ 12 ].

HPA: hypothalamus-pituitary-adrenal

This image has been created by the authors.

Regular exercise has immunomodulatory effects such as optimising catecholamine, lowering cortisol levels, and lowering systemic inflammation. Physical activity has been shown to increase plasma brain-derived neurotrophic factor (BDNF), which is thought to reduce amyloid-beta toxicity linked to Alzheimer's disease progression [ 13 ].

Although no causal correlations have been proven, methodologically sound research has discovered a related improvement in mentally and physically ill populations. These findings are based on research and studies conducted all across the globe, particularly in the Western Hemisphere. In order to address a widespread health problem in India, it is useful to do a literature review that draws on research conducted in a variety of settings. In addition, the prevalence of these mental illnesses and the benefits of exercise as a complementary therapy might be made clear by a meta-analysis of research undertaken in India [ 14 ].

This review also analysed published literature from India to understand the effects of exercise on mental health and the implications for disease management and treatment in the Indian context. Results from Indian studies were consistent with those found in global meta-analyses. The Indian government has made public data on interventions, such as the effects of different amounts of physical exercise. Exercising and yoga have been shown to be effective adjunct therapies for a variety of mental health conditions [ 12 ]. Though yoga may not require a lot of effort to perform, other aspects of the program, such as breathing or relaxation exercises, may have an impact on a practitioner's mental health at the same time. Due to its cultural significance as a common physical practice among Indians and its low to moderate activity level, yoga would be an appropriate activity for this assessment [ 15 ].

Yoga as an adjunctive treatment 

Although yoga is a centuries-old Hindu practice, its possible therapeutic effects have recently been studied in the West. Mind-body approaches have been the subject of a lot of studies, and some of the findings suggest they may aid with mental health issues on the neurosis spectrum. As defined by the National Center for Complementary and Alternative Medicine, "mind-body interventions" aim to increase the mind's potential to alter bodily functions [ 16 ]. Due to its beneficial effects on the mind-body connection, yoga is used as a treatment for a wide range of conditions. Possible therapeutic benefits of yoga include the activation of antagonistic neuromuscular systems, stimulation of the limbic system, and a reduction in sympathetic tone.

Anxiety and depression sufferers might benefit from practising yoga. Yoga is generally safe for most people and seldom causes unintended negative consequences. Adding yoga to traditional treatment for mental health issues may be beneficial. Many of the studies on yoga included meditation as an integral part of their methodology. Meditation and other forms of focused mental practice may set off a physiological reaction known as the relaxation response. Functional imaging has been used to implicate certain regions of the brain that show activity during meditation. According to a wealth of anatomical and neurochemical evidence, meditation has been shown to have far-reaching physiological effects, including changes in attention and autonomic nervous system modulation [ 17 ]. Left anterior brain activity, which is associated with happiness, was shown to rise considerably during meditation. There's also some evidence that meditation might worsen psychosis by elevating dopamine levels [ 18 - 20 ]. We do not yet know enough about the possible downsides of meditation for patients with mental illness, since this research lacks randomised controlled trials.

Physical activity and schizophrenia

Schizophrenia is a debilitating mental disorder that often manifests in one's early years of productive life (late second decade). Remission of this disorder occurs in just a small fraction of cases. More than 60% will have relapses, and they might occur with or without noticeable deficits. Apart from delusions, hallucinations, and formal thought disorders, many patients exhibit cognitive deficits that emerge in the early stages of the disease and do not respond adequately to therapy [ 21 ].

Treatment for schizophrenia is challenging to master. Extrapyramidal side effects are a problem with first-generation antipsychotic drugs. Obesity and dyslipidemia have been related to second-generation drugs, which may cause or exacerbate these conditions. The majority of patients do not achieve complete remission, and many do not even experience satisfactory symptom relief. Even though certain antipsychotic medications may alleviate or even exacerbate negative and cognitive symptoms, these responses are far less common. This means that patients may benefit from cognitive rehabilitation. Because of their illness or a negative reaction to their medicine, they may also have depressive symptoms. This would make their condition even more disabling. Many patients also deal with clinical and emotional complications. Tardive extrapyramidal illnesses, metabolic syndromes, defect states, and attempted suicide are all in this category. Patient compliance with treatment plans is often poor. The caregivers take on a lot of stress and often get exhausted as a result.

Evidence suggests that increased physical activity can aid in attenuating some psychotic symptoms and treating medical comorbidities that accompany psychotic disorders, particularly those subject to the metabolic adverse effects of antipsychotics. Physically inactive people with mental disorders have increased morbidity and healthcare costs. Exercise solutions are commonly recommended to counteract these difficulties and maintain mental and physical wellness [ 22 ].

The failure of current medications to effectively treat schizophrenia and the lack of improvement in cognitive or negative symptoms with just medication is an argument in favour of utilising yoga as a complementary therapy for schizophrenia. Even without concomitant medication therapy, co-occurring psychosis and obesity, or metabolic syndrome, are possible. The endocrine and reproductive systems of drug abusers undergo subtle alterations. Numerous studies have shown that yoga may improve endocrine function, leading to improvements in weight management, cognitive performance, and menstrual regularity, among other benefits. In this context, the role of yoga in the treatment of schizophrenia has been conceptualized. However, yoga has only been studied for its potential efficacy as a therapy in a tiny number of studies. There might be several reasons for this. To begin with, many yoga academies frown against the practice being adapted into a medical modality. The second misconception is that people with schizophrenia cannot benefit from the mental and physical aspects of yoga practised in the ways that are recommended. Third, scientists may be hesitant to recommend yoga to these patients because of their lack of knowledge and treatment compliance.

In a randomised controlled experiment with a yoga group (n = 21) and an exercise group (n = 20), the yoga group exhibited a statistically significant reduction in negative symptoms [ 2 ]. In accordance with the most recent recommendations of the National Institute for Health and Care Excellence (NICE), the above research provides substantial evidence for the use of yoga in the treatment of schizophrenia. According to a meta-analysis of 17 distinct studies [ 23 ] on the subject, frequent physical activity reduces the negative symptoms associated with schizophrenia considerably.

Physical activity and alcohol dependence syndrome

Substance abuse, namely alcohol abuse, may have devastating effects on a person's mental and physical health. Tolerance and an inability to control drinking are some hallmarks of alcoholism. Research shows that physical activity is an effective supplement in the fight against alcohol use disorder. In addition to perhaps acting centrally on the neurotransmitter systems, physical exercise may mitigate the deleterious health consequences of drinking. Evidence suggests that persons with alcohol use disorder are not physically active and have low cardiorespiratory fitness. A wide number of medical comorbidities, like diabetes mellitus, hypertension, and other cardiovascular illnesses, occur with alcohol use disorders. Physical exercise may be highly useful in aiding the management of these comorbidities [ 24 ].

Physical exercise and yoga may help in the management of cravings for substances when other forms of therapy, such as counselling or medication for craving management are not feasible or acceptable. Physical exercise has been shown to have beneficial effects on mental health, relieve stress, and provide an enjoyable replacement for the substance. However, the patient must take an active role in physical activity-based therapies rather than passively accept the process as it is, which is in stark contrast to the approach used by conventional medicine. Since most substance use patients lack motivation and commitment to change, it is recommended that physical activity-based therapies be supplemented with therapies focusing on motivation to change to maximise therapeutic outcomes.

One hundred seventeen persons with alcohol use disorder participated in a single-arm, exploratory trial that involved a 12-minute fitness test using a cycle ergometer as an intervention. Statistically, significantly fewer cravings were experienced by 40% [ 24 ]. Exercise programmes were found to significantly reduce alcohol intake and binge drinking in people with alcohol use disorder in a meta-analysis and comprehensive review of the effects of such therapies [ 25 ].

Physical activity and sleep

Despite widespread agreement that they should prioritise their health by making time for exercise and sufficient sleep, many individuals fail to do so. Sleep deprivation has negative impacts on immune system function, mood, glucose metabolism, and cognitive ability. Slumber is a glycogenetic process that replenishes glucose storage in neurons, in contrast to the waking state, which is organised for the recurrent breakdown of glycogen. Considering these findings, it seems that sleep has endocrine effects on the brain that are unrelated to the hormonal control of metabolism and waste clearance at the cellular level. Several factors have been proposed as potential triggers for this chain reaction: changes in core body temperature, cytokine concentrations, energy expenditure and metabolic rate, central nervous system fatigue, mood, and anxiety symptoms, heart rate and heart rate variability, growth hormone and brain-derived neurotrophic factor secretion, fitness level, and body composition [ 26 ].

After 12 weeks of fitness training, one study indicated that both the quantity and quality of sleep in adolescents improved. Studies using polysomnography indicated that regular exercise lowered NREM stage N1 (very light sleep) and raised REM sleep (and REM sleep continuity and performance) [ 22 ]. As people age, both short- and long-term activities have increasingly deleterious effects on sleep. In general, both short- and long-term exercise were found to have a favourable effect on sleep quality; however, the degree of this benefit varied substantially among different sleep components. On measures of sleep quality, including total sleep time, slow-wave sleep, sleep onset latency, and REM sleep reduction, acute exercise had no effect. But both moderate and strenuous exercise has been shown to increase sleep quality [ 27 ]. According to a meta-analysis of randomised controlled trials, exercise has shown a statistically significant effect on sleep quality in adults with mental illness [ 28 ]. These findings emphasise the importance that exercise plays in improving outcomes for people suffering from mental illnesses.

Physical activity in depressive and anxiety disorders

Depression is the leading cause of disability worldwide and is a major contributor to the global burden of disease, as per the World Health Organization. However, only 10%-25% of depressed people actually seek therapy, maybe due to a lack of money, a lack of trained doctors, or the stigma associated with depression [ 29 ]. For those with less severe forms of mental illness, such as depression and anxiety, regular physical exercise may be a crucial part of their treatment and management. Exercise and physical activity might improve depressive symptoms in a way that is comparable to, if not more effective than, traditional antidepressants. However, research connecting exercise to a decreased risk of depression has not been analysed in depth [ 30 ]. Endorphins, like opiates, are opioid polypeptide compounds produced by the hypothalamus-pituitary system in vertebrates in response to extreme physical exertion, emotional arousal, or physical pain. The opioid system may mediate analgesia, social bonding, and depression due to the link between b-endorphins and depressive symptoms (Figure ​ (Figure2 2 ).

The "endorphin hypothesis" states that physical activity causes the brain to produce more endogenous opioid peptides, which reduce pain and boost mood. The latter reduces feelings of worry and hopelessness. A recent study that demonstrated endorphins favourably improved mood during exercise, and provided support for these theories suggested that further research into the endorphin theory is required [ 31 ].

Physical activity and exercise have been shown to improve depressive symptoms and overall mood in people of all ages. Exercise has been implicated in lowering depressive and anxious symptoms in children and adolescents as well [ 32 ]. Pooled research worldwide has revealed that physical exercise is more effective than a control group and is a viable remedy for depression [ 33 ]. Most forms of yoga that start with a focus on breathing exercises, self-awareness, and relaxation techniques have a positive effect on depression and well-being [ 34 ]. Despite claims that exercise boosts mood, the optimal kind or amount of exercise required to have this effect remains unclear and seems to depend on a number of factors [ 35 ].

Exercise as a therapy for unipolar depression was studied in a meta-analysis of 23 randomised controlled trials involving 977 subjects. The effect of exercise on depression was small and not statistically significant at follow-up, although it was moderate in the initial setting. When compared to no intervention, the effect size of exercise was large and significant, and when compared to normal care, it was moderate but still noteworthy [ 36 ]. A systematic evaluation of randomised controlled trials evaluating exercise therapies for anxiety disorders indicated that exercise appeared useful as an adjuvant treatment for anxiety disorders but was less effective than antidepressant treatment [ 37 ].

Conclusions

The effects of exercise on mental health have been shown to be beneficial. Among persons with schizophrenia, yoga was shown to have more positive effects with exercise when compared with no intervention. Consistent physical activity may also improve sleep quality significantly. Patients with alcohol dependence syndrome benefit from a combination of medical therapy and regular exercise since it motivates them to battle addiction by decreasing the craving. There is also adequate evidence to suggest that physical exercise improves depressive and anxiety symptoms. Translating the evidence of the benefits of physical exercise on mental health into clinical practice is of paramount importance. Future implications of this include developing a structured exercise therapy and training professionals to deliver it. The dearth of literature in the Indian context also indicates that more research is required to evaluate and implement interventions involving physical activity that is tailored to the Indian context.

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The authors have declared that no competing interests exist.