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Year : 2012  |  Volume : 136  |  Issue : 2  |  Page : 301-303

Outdoor physical activity & cardiovascular health

Professor of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram 695 011, India

Date of Web Publication7-Sep-2012

Correspondence Address:
S Sivasankaran
"Sree Gomathy", CRA 21, Kairali Lane Perunthanny, Vallakadavu PO Thiruvananthapuram 695 008, Kerala
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Source of Support: None, Conflict of Interest: None

PMID: 22960901

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How to cite this article:
Sivasankaran S. Outdoor physical activity & cardiovascular health. Indian J Med Res 2012;136:301-3

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Sivasankaran S. Outdoor physical activity & cardiovascular health. Indian J Med Res [serial online] 2012 [cited 2021 May 18];136:301-3. Available from:


The article by Marwaha et al[1] on the effect of sports training on bone mineral density in young Indian healthy females carries the key public health message for the authorities to take note of, in preventing escalation of non-communicable disease risk factors in the younger age group in India. Apt timing of this publication coincided with the World Heart Day activities of 2011 [2] . This study looked at the effect of two important behavioural risk factors namely diet and physical activity on one of the major components of body composition namely bone mineral density. Exercise improves bones, builds muscles, and it is the best for cardiovascular health, especially in women [3] . Vitamin D deficiency seems to be universal and outdoor physical activity, in this study, doubles its blood levels [1] .

Of the four behavioural risk factors for non-communicable diseases, namely the unhealthy diet, physical inactivity, tobacco use and alcohol consumption, the two risk factors, tobacco use and alcohol consumption are practically not observed in adolescent girls in India [4] . In adolescent women, two behavioural risk factors viz. unhealthy diet, and physical inactivity lay the foundation for four major non-communicable diseases, namely, diabetes, cardiovascular diseases, osteoporosis and cancer, which form the major reason for more than 50 per cent of morbidity and mortality in their life course [5] . The exponential increase in risk factors in women of child bearing age group is the outcome of the indulgence of adolescent children in unhealthy diet and physical inactivity [6] . This study also stresses the need for outdoor physical activity to improve the vitamin D status. We are now aware of the role of vitamin D in the genesis of adiposity, diabetes, and cardiovascular risk and this could be a factor in the ethnic differences in risk profile [7] . These risk factors in pregnant women herald the early onset of diseases in the next generations, because of epigenetic reasons [8],[9] . Adolescence is the last opportunity to improve the body composition and helps to attain the best possible body composition as a mother [10] . Vitamin supplementation may not be enough, we need a stimulus for the bones and muscles to grow, and outdoor physical activity is the simple prescription which does all.

Two important aspects of non-communicable disease epidemiology in the developing world are the escalation of risk factors and diseases at a young age and failure of anthropometric markers of obesity to predict them [11],[12] . The loss of biological delay in the onset of cardiovascular risk factors and diseases in women in societies undergoing epidemiologic transition formed the basis of 'Go red for Women' campaign by the American Heart Association since 2004 [13] . The State of Kerala heralds India in terms of health transitions [14] . Studies on acute coronary syndrome admissions in Kerala reveal a steady decline in the male to female ratio from 23:1 to 4:1 from 1967 to 2007 [12],[15] . Breast cancer incidence has increased at least four times [16] . Several community surveys have shown that women suffer a heavy burden of non-communicable disease risk factors [17] . A survey done in children in Kerala has shown a peculiar step increase in systolic blood pressure in girls at adolescence, coinciding with social barriers which restrict physical activity in girls at puberty [18] . Gestational diabetes has increased four times in south India. In the recent epidemiologic survey in Kerala, 3.7 per cent of the people below the age of 30 yr were diabetic and all were women [17] .

The declining physical activity at adolescence has been correlated with increasing academic pressure [20] . Vitamin D synthesis is 4 to 6 times less in dark pigmented people, and adolescent girls need 6 times more vitamin D given their increased demands of growth, pregnancy and lactation [21] . Salt is an essential factor which contributes for acidification of the body, and loss of bone mineral density. Studies from India suggest almost double the recommended salt consumption [22],[23] .

Skeletal muscles contribute for more than 60 per cent of the body insulin sensitivity, contrary to the much discussed role of fat cells in insulin resistance [24] . Low birth weight babies in India are not chubby, not because they lack fat, but because they lack the skeletal muscle [25] . Maternal vitamin D levels, folate-B 12 levels, and dysglycaemia are documented intra-uterine risk factors. Outdoor physical activity is the best way to overcome many of these abnormalities. We need to take away the academic pressure from the adolescent children and they should have a physically active life to doze the wild fire of lifestyle diseases. There is a need to move away from the adipocentric approach to more biologic approach of assessing the body response to the epidemiologic transition.

Exercise builds muscles and bones, buffers the insult of high calorie nutrition and is the key for healthy ageing. No wonder, atherosclerosis is not a natural disease of animals, they remain physically active, indulge in natural foods and do not cover their body from the sun.

   Acknowledgment Top

Author acknowledges the Fogarty International Center and the Eunice Kennedy Shriver National Institute of Child Health & Human Development at the National Institutes of Health, USA (grant number 1 D43 HD065249) for the financial assistance.

   References Top

1.Marwaha RK, Puri S, Tandon N, Dhir S, Agarwal N, Bhadra K, et al. Effects of sports training & nutrition on bone mineral density in young Indian healthy females. Indian J Med Res 2011; 134 : 307-13.  Back to cited text no. 1
2.Colombo A. World Heart Day: education is the key. Indian J Med Res 2011; 134 : 247-9.  Back to cited text no. 2
3.Sattelmair J, Pertman J, Ding EL, Kohl HW 3 rd , Haskell W, Lee IM. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation 2011; 124 : 789-95.  Back to cited text no. 3
4.IDSP-NCD risk factor survey. Available from:, accessed on October 5, 2011.  Back to cited text no. 4
5.Beaglehole R, Bonita R, Alleyne G, Horton R. NCDs: celebrating success, moving forward. Lancet 2011; 378 : 1283-4.  Back to cited text no. 5
6.Gupta R, Misra A, Vikram NK, Kondal D, Gupta SS, Agrawal A, et al. Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC Cardiovasc Disord 2009; 9 : 28.  Back to cited text no. 6
7.Pacifico L, Anania C, Osborn JF, Ferraro F, Bonci E, Olivero E, et al. Low 25(OH)D3 levels are associated with total adiposity, metabolic syndrome, and hypertension in Caucasian children and adolescents. Eur J Endocrinol 2011; 165 : 603-11.  Back to cited text no. 7
8.Krishnaveni GV, Veena SR, Hill JC, Kehoe S, Karat SC, Fall CH. Intrauterine exposure to maternal diabetes is associated with higher adiposity and insulin resistance and clustering of cardiovascular risk markers in Indian children. Diabetes Care 2010; 33 : 402-4.  Back to cited text no. 8
9.Krishnaveni GV, Veena SR, Winder NR, Hill JC, Noonan K, Boucher BJ, et al. Maternal vitamin D status during pregnancy and body composition and cardiovascular risk markers in Indian children: the Mysore Parthenon Study. Am J Clin Nutr 2011; 93 : 628-35.  Back to cited text no. 9
10.Daniels SR, Pratt CA, Hayman LL. Reduction of risk for cardiovascular disease in children and adolescents. Circulation 2011; 124 : 1673-86.  Back to cited text no. 10
11.Prabhakaran D, Yusuf S. Cardiovascular disease in India: Lessons learnt & challenges ahead. Indian J Med Res 2010; 132 : 529-30.  Back to cited text no. 11
12.Sivasankaran S, Nair MK, Babu G, Zufikar AM. Need for better anthropometric markers for prediction of cardiovascular risk in nutritionally stunted populations. Indian J Med Res 2011; 133 : 557-9.  Back to cited text no. 12
13.Franceski BD. Cardiovascular health in women: an overview of gender-related issues. Adv Emerg Nurs J 2009; 31 : 63-72.  Back to cited text no. 13
14.Peters DH, Rao KS, Fryatt R. Lumping and splitting: the health policy agenda in India. Health Policy Plan 2003; 18 : 249-60.  Back to cited text no. 14
15.Mammi MV, Pavithran K, Abdu Rahiman P, Pisharody R, Sugathan K. Acute myocardial infarction in north Kerala - a 20 year hospital based study. Indian Heart J 1991; 43 : 93-6.  Back to cited text no. 15
16.Yeole BB, Kurkure AP. An epidemiological assessment of increasing incidence and trends in breast cancer in Mumbai and other sites in India, during the last two decades. Asian Pac J Cancer Prev 2003; 4 : 51-6.  Back to cited text no. 16
17.Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al. Risk factor profile for chronic non-communicable diseases: results of a community-based study in Kerala, India. Indian J Med Res 2010; 131 : 53-63.  Back to cited text no. 17
18.Raj M, Sundaram KR, Paul M, Kumar RK. Blood pressure distribution in children. Indian Pediatr 2009; 47 : 477-85.  Back to cited text no. 18
19.Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Athi T, Thamizharasi M, et al. Prevalence of gestational diabetes mellitus in South India (Tamil Nadu) - a community based study. J Assoc Physicians India 2008; 56 : 329-33.  Back to cited text no. 19
20.Swaminathan S, Selvam S, Thomas T, Kurpad AV, Vaz M. Longitudinal trends in physical activity patterns in selected urban south Indian school children. Indian J Med Res 2011; 134 : 174-80.  Back to cited text no. 20
21.Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96 : 1911-30.  Back to cited text no. 21
22.Frassetto LA, Morris RC Jr, Sellmeyer DE, Sebastian A. Adverse effects of sodium chloride on bone in the aging human population resulting from habitual consumption of typical American diets. J Nutr 2008; 138 : 419S-22S.  Back to cited text no. 22
23.Misra A, Singhal N, Sivakumar B, Bhagat N, Jaiswal A, Khurana L. Nutrition transition in India: secular trends in dietary intake and their relationship to diet-related non-communicable diseases. J Diabetes; 2001; 3 : 278-92.  Back to cited text no. 23
24.Eaton SB, Cordain L, Sparling PB. Evolution, body composition, insulin receptor competition, and insulin resistance. Prev Med 2009; 49 : 283-5.  Back to cited text no. 24
25.Yajnik CS, Fall CH, Coyaji KJ, Hirve SS, Rao S, Barker DJ, et al. Neonatal anthropometry: the thin-fat Indian baby. The Pune Maternal Nutrition Study. Int J Obes Relat Metab Disord 2003; 27 : 173-80.  Back to cited text no. 25


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