Doctors and exercise :

Dr Shantanu Deshpande,
Padmashree Dr D Y Patil Hospital, Nerul, Navi Mumbai
We Doctors revel in our role as doorkeepers of healthcare. But are we really health conscious
ourselves? Do we really follow healthy practices which we earnestly advocate to patients?
Unfortunately, in a majority of cases, the answer to this question is no! It is common sight to
behold obese health care personnel, who neither exercise nor refrain from indiscriminate
smoking. It is no wonder then that there is a tremendous spurt in reports of young doctors dying
suddenly without any apparent reason. Stress, lack of physical activity, untimely meals have
become part of doctors lifestyle. Unfortunately, we seem to we boast of this redoubtable trend.
We are proud to practice till late hours hoping to impress our peers. Number of surgeries or
procedures performed in a month has become style statement for us. Lifestyle diseases like
diabetes, hypertension and dyslipidemias at young age are a known fact in doctors. Also,
physically unfit doctors fail to instill confidence in patients. Lack of physician health
programmes in any of institutes in India adds to this lack of awareness. There is growing need of
assistance to doctors to tackle physical, mental and addictive problems. Lack of data in India in
this regard is appalling. A cross-sectional questionnaire about lifestyle, food habits, work hours
and addictions along with calculation of BMI, BP and basic blood parameters for doctors in
major institutes would help us to define the extent of this problem.
I myself have had the dubious distinction of having suffered from the same malady.
Prolonged work hours, erratic food habits and nil planned physical activities culminated in
deranged lipid profile, rise in blood pressure and irritable moods. A year back an introspective
event led me to swear to myself that enough was enough and to change my lifestyle completely. I
decided to run for half marathon. It was a difficult but ultimately fantastic journey from being a
couch potato to marathoner. Initially I was not able to run for even 5 minutes. Motivations,
consistency and a scientific approach to running lead me to accomplish my goal.
I am often asked if I get a prize for running. Well, I run for myself. The pleasure I derive after
running for 2 hrs is second to none. Once I start running, first few kilometers go in getting into
rhythm. Once it sets in, the legs, core, hands start moving synchronously and unconsciously.
Slowly a state of calmness enters the mind. Its an ultimate transcendental feeling. Endorphins
set good mood for the whole day. Exercise makes one conscious about food habits. I have
become conscious of type and timings of food that I eat. Did I compromise on work so as to fit in
the exercise schedule? Not at all! In fact a little time management and discipline has helped me
to work more in restricted work hours. Within 6 months I lost 7 kgs weight (from 77 kg to 70
kgs) and my waistline reduced from 36 to 31inches. My paunch was gone and blood pressure
normalized. The lipid profile improved. I also started reading a lot about running. Exercise is a
neglected topic in whole medical curriculum, even though it is one of the easiest, cheapest and
effective preventive strategy for many of illnesses.
Health benefits are derived mainly from aerobic kinds of exercise. Aerobic exercises are
the ones in which energy utilization (fat or glucose metabolism in TCA cycle) occurs aerobically,
maximizing ATP output to 38. Running, walking, swimming, cycling are examples of the aerobic
exercises. There are two major kinds of muscle fibres in body, red and white. Red fibres (Type I)
are rich in mitochondria and myoglobin, where as white fibres (Type II) are low in myoglobin
content and mitochondria but have high myosin ATPase activity.
[1]
A number of studies have
shown that muscles in elite athletes have a specific pattern of percentage of type of fibres.
Muscles of sprinters, weightlifters and jumpers have high density of white fibres whereas
endurance runners, swimmers have high density of red fibres. Aerobic exercise uses FFA (free
fatty acids) as fuel especially after initial 15 -20 mins of exercise (red fibres), whereas muscle
glycogen is used as fuel for anaerobic exercise. (Sprinters, weight lifters). These differences in
density of type of fibres are genetically determined. Probably that explains dominance of athletes
of African origin in these sports
[2]

For a couch potato to start from zero to marathon requires attention to two core issues.
First, the development of muscle endurance/strength.Second,improving cardiovascular fitness.
Exercise results in increased muscle activity for which more oxygen is needed, which is provided
by increase in stroke volume and heart rate by heart. Cardiovascular fitness consists of three
things. Ability of lungs (for oxygenation), adequate haemoglobin (oxygen carrier) and functional
capacity of heart (oxygen pump). If any of these systems are not geared to keep up with demands
from exercising muscles then there will be reduction in exercise capacity in the form undue
fatigue and dyspnea. In nut shell one needs to work on muscle endurance gradually by increasing
the distance one walks (Mileage) and increase cardiovascular fitness by interval training.
What are benefits of exercise? It is been shown in many studies that moderate level of
exercise reduces risk of hypertension, diabetes, increases HDL cholesterol levels (good
Cholesterol), increases density of bones, controls weight, improves mood, etc.
There are some rough guidelines for those who want to start an exercise programme.
1. First of all most of us are doing this for some purpose, which is usually physical well
being or weight loss. Nobody here is in race to win a competition. So goals can be fine as
motivation but should not be at expense of injury, or ill health
2. A word of caution- those who are starting all this after age of 40 and have risk factors
like Diabetes, blood pressure, smoking, family history of heart disease. It is advisable to get a
stress test done prior to attempting to run for prolonged periods
3. Build on mileage with focus on time spend on ground rather than distance and speed
4. Gradually build up time spend (10% increase every month )
5. Work on core body. The whole concept in running or swimming is moving towards core
body development. One needs a strong spine, abdominals and hip flexors for running for
prolonged periods. Running form gets affected if these are weak. They are also needed to
keep vertical leaning posture from ankle. So apart from running, it is necessary to exercise
for abs, spine and upper body
6. Rather than rush into Jog-Jog, it may be preferable to start by Walk-jog-walk for
improving stamina.
7. If the aim is weight loss, diet is equally important.
8. Once one can run for 2-3 km continuously, working on the running form comes into
the play.
9. It is vitally important to respect and listen to the body. Every individual is different.
One person can be naturally blessed with a good speed /endurance, while another may have
to strive for it.
These are general guidelines; there are many structured programmes available for serious
runners.
Lastly, I remember scene from Forrest Gump in which Tom Hanks is asked by reporters why
exactly are you running? Are you doing this for world peace? Are you doing this for women's
right or for the environment or for animals? Or for nuclear arms?
He answers because I just felt like running!!
Once one is a runner, there is no need for a cause to run. To experience that heavenly feeling of a
runners high, one needs to simply run.
References |( Please check the reference format in authors instructions)
1. Juraj Arbanas, Gordana Starcevic Klasan, Marina Nikolic. ( Year of Publication) Fibre type
composition of the human psoas major muscle with regard to the level of its origin Name of the
journal/book, Vol No. Page No.
2. Name of the anuthors J Anat. 2009 Title of the research paper, December; 215(6):
636641.
3. Bruce Hamilton East African running dominance: what is behind it? Br J Sports
Med 2000;34:391-394.