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“Health is Wealth”.

There would be few amongst us who would have not heard this all famous quote. Since the dawn of time, man has always shown his superiority over fellow men by feats of physical prowess.  The importance of fitness is imbibed in us by a very early age. Indeed most childhood memories do consist of flashes of vigorous outdoor games. Then why is that even though we know of its importance, we do not care? People always complain of obesity and heart disease running in their family. As the saying goes, ”It’s not that obesity and heart disease that runs in your family, it’s that your family does not run”.   It sounds cruel but the stark reality exists. Whether it be a polar bear fighting for its mate or man fighting the battle against diseases, in the race for survival, fitness does matter.

Why is it that we have such a difficult time complying with something we know to be good for us? The answer is simple. It is infinitely easier and enjoyable to just gorge ourselves on food while just sitting around. It was found in a recent study that every 2 in 3 adults are known to be obese in the country with 1 in 20 of them considered extremely obese (Diseases, 2015).  Yes, this figure is quite horrifying does require remediation.

To remediate one must first understand the problem. Many a time, patients do have the will to exercise but no idea how to go about it, other times they do not have the will to get through it, whatever may be the case, individual problems have to be understood and only then can solutions be offered. I would like to suggest an approach called the EMT approach (Education, Motivation, Tailored Exercise).


Like all diseases, a huge proportion of the reluctance to perform physical activities may be attributed to the lack of knowledge about its benefits.  It is important, nay, the duty of the doctor to spread awareness regarding this. Camps must be conducted in schools and other primary health care centres as it is always beneficial to catch them young. A routine built during childhood will encourage further compliance in adulthood.

One may have heard the benefits of exercise in helping with weight loss and reducing incidence of heart disease, Diabetes, Hypercholesterolemia (high cholesterol) and Hypertension (high bp). Some of the lesser known benefits to exercise are:

Improves Energy and Learning: According to Pete McCall, the famous Exercise Physiologist at the American Council on Exercise,  ‘if a sedentary person were to start an exercise program, the blood flow carrying oxygen and nutrients to muscle tissue improving their ability to produce more energy (the chemical adenosine triphosphate) ’. This helps in relieving fatigue as well as improving concentration (McCall, 2015). Indeed the landmark study done by Peutz T.W. et al that appeared in the March 2008 issue of the Swiss Journal  Psychotherapy and Psychosomatic does confirm these findings (Puetz, Flowers e O’Connor, 2008).

Improves Mood and Reduces Anxiety:  While exercise may be the last thing one may want to do while feeling down, studies show there is indeed a beneficial effect of exercise on depressed patients (health, 2015). When an individual exercises, the brain releases Dopamine, Adrenaline, Serotonin and Endorphins. Dopamine is the happy hormone of the human body helping us to feel good while Endorphins enhance pleasure. This explains the feeling of elation body-builders experience after a workout even though their bodies might be crying out with pain. Also, exercise has the added advantage of releasing the strain in the muscles (Stibich, 2015).

Promotes better quality sleep: There are numerous reports on how exercise affects sleep and vice versa.  A study published  in Journal of Clinical Sleep Medicine by Dr.KG Baron mentiones the importance of exercise in improving sleep in insomnia (Baron, Reid e Zee, 2013). However, Dr.Kelly Glazer Baron, a clinical psychologist and clinical researcher at the Fienberg School of Medicine at NorthWestern University also goes on to say that sleep may have an effect on exercise more convoluted than we thought and that a bad night’s sleep may affect the next day’s work out as well (Kelly Fienberg Baron).

Improves self-esteem and body Image: Now here is one that needs no explanation. There is no denying the fact that looking good also makes you feel good. JR Hughes in paper titled “Psychological effects of habitual aerobic exercise : A critical review” evaluated the effect  on mood, personality and cognition and came to the conclusion that exercise does indeed improve self-concept.

Sharpens Memory ad improves learning: Recent reports suggest that regular exercise does in fact improve memory(Antunes et al., 2015). The land mark trials by Ahn N and Kim K, shows the improvement of memory in Alzhiemers patients with regular upper and lower extremity exercise (Ahn e Kim, 2015). Terrence J.Sejnowsi and his team found that voluntary running led to growth of new neurons and improves learning and memory in mice. In his own words ” Until recently it was thought that the growth of new neurons, or neurogenesis, did not occur in the adult mammalian brain, But we now have evidence for it, and it appears that exercise helps this happen” (sejnowski, 2015).

Improves Sex Life:  Yes!! It does!! There are several reasons why. The most logical would be the increased muscle tone that would help maintain those difficult positions as well as improve orgasms. Stamina too plays an important role especially for more mature adults. Physical fitness also relates to increased libido. Also, sex is as much mental as physical and it should come as no surprise that a fit person would be more confident in the bedroom (Shealy, 2015).



  • Stibich, M. Exercise to Improve Your Mood and Fight Depression.   Disponível em: < >.
  • Baron, K. G.; Reid, K. J.; Zee, P. C. Exercise to improve sleep in insomnia: exploration of the bidirectional effects. J Clin Sleep Med, v. 9, n. 8, p. 819-24, ISSN 1550-9389. Disponível em: < >.
  • Antunes, H. K. et al. Effects of a physical fitness program on memory and blood viscosity in sedentary elderly men. Braz J Med Biol Res, p. 0, Jul 28 2015. ISSN 0100-879x. Disponível em: <×20154529 >.
  • Ahn, N.; Kim, K. Effects of an elastic band resistance exercise program on lower extremity muscle strength and gait ability in patients with Alzheimer’s disease. J Phys Ther Sci, v. 27, n. 6, p. 1953-5, Jun 2015. ISSN 0915-5287 (Print)0915-5287. Disponível em: < >.



Once the patient has been educated on the benefits of exercise, it is time to motivate the patient to begin it. This may occur in the following ways:

  • Inspiration: it is important to empathize (note, not sympathize) with the patient and make him understand that it might be difficult but never impossible for him to achieve his goals.
  • Set goals: This is very important. No obese person can become a tone down and bulk up in a matter of days. The patient should be told this and realistic goals should be set. A good way would be to plan a program with initially the loss of 1kg/week as the target and then build up from there. Giving dreams as to having bodies of the like of Arnold Schwarzenegger and Sylvester Stallone will only serve to demotivate the person as he will acknowledge the impossibility.
  • Provide incentives: This worked for Pavlov and it will work for us. Small rewards on achieving small goals will help keep the patient motivated enough to comply with the program. This could be something as simple as downloading a new song after each week survived to huge rewards as new running shoes at the end of a month. The patient should figure out what is good for him and set his own rewards.
  • Healthy Competition: It is always better to begin training with a partner as this spurs each other into action. Also comparing achievements after each day/week helps keeps people on their toes.
  • Wrist-Bands: For the more experienced, wrist-bands help as both a motivational tool.
  • Regular Visits with Dietician/Doctor: This again is just a tool in compliance and regular motivational therapy will help the passion alive.


Not everyone is the same. Similarly, not everyone needs the same training menu. Different exercises provide different effects on the body. These are:

Aerobic Exercise: Here the emphasis is on improvement of stamina. The lungs have many arteries and capillaries (connecting arteries) supplying it. Only about 60% of it is actually used. When we exercise, to maintain the increased oxygen demand of the muscles, the unused channels open up. They then collapse after the need is met. In people who regularly exercise, these channels remain open for a longer period of time thus improving overall capacity and cardiac output. Hence, “Cardio”.

These exercises are especially good for overall body function. All people should be put on a version of this. Some of the more common types of aerobic exercise are swimming, cycling, jogging and aerobics. Special care must be taken in view of age and capacity before deciding what kind of exercise must be prescribed.

Anaerobic exercise: This concentrates on strength and this is not for everyone. Dumbells, Barbells and exercise machines are a part and parcel and this is for those people who dream of Schwarzenegger-esque bodies. There are however, studies that suggest a beneficial effect of heavy resistance training in post-menopausal women with low bone mass (Watson et al., 2015).

Flexibility: Now this is the stuff of every man’s dreams. The more flexible you are, the easier motion is and in extension, easier sex is. However, its effects do not stop there. Though a relatively new discipline, it is coming up in a very wide fashion. Some notable examples are Yoga, Pilates and Kegel.

The doctor, in consult with a dietician and trainer must write up a training menu for the patients tailored to their routines. For example, it would be much better to put a person with access to a swimming pool on the swimming routine while opting for other methods for the rest. The individual interests of the patient should also be taken into consideration. Special Care must be taken to include the patients’ daily routine while planning.

Can I really afford this?

This is a common question asked by many. While good gyms and accessories do cost money, staying fit does not. All you need is the right attitude. The true testament to this fact is Boxing . Boxing is a sport that requires peak physical form. It is one of those few sports that require one to excel in all the types of exercise. However, almost all major champions have come from backgrounds where money was scarce to nil. Their rise to success is always stuff of legend. All they started out with is a clear goal. This holds true for each of us trying to win our own match be it with one kilogram or fifty.

Ultimately, one has to realize that to exercise is not a routine but a way of life. Yes, the path may be difficult but the rewards are more than great.


It should come as no surprise that students studying for USMLE and other major exams spend most of their time hunched over books. This leads to ill-health which may affect exams and definitely affects one’s future. The lifestyle change incurred here is difficult to change. Exercise not only keeps you fit but I fact may help a person to study more. A few basic exercises for the USMLE student are breathing exercises which may be done after each set of questions or even between exam sets, timed jogs in a day to get blood pumping and for the inclined, push ups and sit ups which may be done inbetween studies. Revision or even repetition of concepts may be done in between sets.




  • Watson, S. L. et al. Heavy resistance training is safe and improves bone, function, and stature in postmenopausal women with low to very low bone mass: novel early findings from the LIFTMOR trial. Osteoporos Int, Aug 5 2015. ISSN 0937-941x. Disponível em: < >.
Dr.Harpreet Singh MD, FACP is a Chief Executive Officer and Founder of Vital Checklist and The text, graphics, images, videos and other material contained in the videos and iCrush Website ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Dilip Rajasekharan- Executive Editor and Author
Dr.Dilip Rajasekharan is a graduate of Kasturba Medical College, Mangalore, a reputed college of the Manipal University family. An advocate of Health Literacy, Dilip has spent countless hours volunteering in the underprivileged areas spreading health education. A keen researcher and prolific writer, he has penned more than eighty articles on Patient Education. A true follower of the teachings of William Osler, he aspires to practice that medicine which not only treats the patient but also improves all facets of a patient’s life. A competitive swimmer and accomplished mountain climber, he propounds the need for spreading ones wings and incorporation of multiple tenets to one’s life in the quest for happiness.

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