Exercise is now the big treatment for almost all major disease. Medical reports and studies suggest that regular exercise delays or even prevents the onset of adult diabetes, heart disease, senility and a perhaps even cancer.

Exercise is an imposition. Find time for it and then go to a gym or some such place and spend maybe half an hour every day, running on a treadmill or doing more complicated stuff. In the busy lives that we now lead, to find time for regular exercise is difficult. Even if there is time the ‘idiot box’ the game box, and the computer are all there to keep us occupied. That is exactly the reason why in the real world, most people don’t exercise regularly.

In the United States, for instance, people enrol in gyms during the beginning of a new year as a part of a new year resolution, turn up perhaps for a couple of weeks regularly and then forget all about it. As I said above, regular exercise is an imposition.

Much is made of the superiority of the ‘Mediterranean Diet’. Olive oil and red wine are supposed to be the essential ingredients that make people live longer. But then visit that part of the world and you will see that people walk, walk to work, walk to the store, walk up and down the hills as part of normal activity every day.

Obesity and its associated health problems are pretty much reaching ‘epidemic’ levels in the US these days. But then an interesting observation is in order. The last time I visited the United Kingdom and spent time with friends and relatives, when I asked somebody how far was the nearest grocery store or the nearest ‘tube’ station, they would say ‘ten minutes away’. They meant a ten minute walk. Ask a similar question in the US, and the answer ‘ten minutes away’ means a ten minute drive in a car.

More than 40 years ago when I was a student in King Edward Medical College, other than our professors, almost all students and staff members, including our assistant professors, came to college on bicycles. But now everybody comes to college either in a car or on a motorbike or else takes some form of motorised transport. The same is true today of most people that come to work in our offices and homes.

Other than farmers working the fields, nobody, except the very poor, walk to any place any more. Obviously, those that read this column are neither very poor nor work in the fields. So, for them I have only one thing to say. Sadly, you are at a high risk for obesity, diabetes, and heart disease. But all is not lost.

The basic applicable ‘equation’ is the calories we consume and the calories we burn up. Depending on size, during a 24 hour period, an average adult male needs about 1800 calories, and an average adult female about 1500 calories just to provide energy for normal body functions. Any caloric intake more than that, if not burned up by physical activity, will be stored in the body as fat. Important to remember here is that it takes more than a brisk four-mile walk to burn up just one fast food ‘hamburger’.

Even if we restrict our total caloric intake and eat the ‘right’ things, exercise is still good for health. Exercise offers many benefits besides weight control. As a matter of fact exercise should not be considered as a primary method of weight control at all.

So let us count some of the ‘other’ benefits of exercise. First, regular exercise raises the ‘metabolic’ rate (how fast the body works) so that the body generally burns up more calories but this effect is limited. In food terms, for an average person it is just about equal to the calories present in two ‘chappatis’.

Exercise improves the function of the heart, and even in patients with heart artery blockages, it stimulates increase flow of blood to the heart muscle through what are known as ‘collaterals’. These are small arteries that develop through exercise to supply parts of the heart muscle that have lost their primary source of blood supply.

Besides the effect on the heart, exercise also increases flow of blood to all parts of the body and there is definite evidence that it can help with that bane of masculinity known as ‘erectile dysfunction’ or loss of male potency. Exercise also improves blood flow to the brain and delays or possibly even prevents the onset of many mental changes seen in old age. And indeed, regular exercise improves our ‘mood’ and makes us feel better!

Also, exercise seems to be one of few ways we have to increase the amount of good cholesterol in the blood. And it does seem that exercise can delay the onset of diabetes and high blood pressure and once diabetes and high blood pressure develop, exercise does help in controlling both of these problems better than medicines alone.

Regular exercise also strengthens muscles and bones and decreases the risk of serious fractures as we get older. Evidence that exercise decreases the risk of certain types of cancers like those of the large intestine and the breast exists but is difficult to prove directly.

From a general perspective, regular exercise is definitely associated with a longer and a healthier life. Having sort of established that exercise is good for you, the question then is, are there any down sides? Indeed there are. First and most importantly people in their forties or more that have never exercised for many years have to be careful.

So if you are in your forties, slightly overweight and haven’t played any sport regularly, but now you want to live better and longer, go see a doctor first. Get your sugar and cholesterol levels checked and if you have any risk factors for heart disease get a stress test so that you don’t have a major heart attack while running on a treadmill. Equally important is a plan about an appropriate diet and other life style modifications.

Benefits of exercise are equally applicable to regular physical activity like walking. Medical information suggests that a brisk walk for perhaps around 30 minutes every day provides the same overall health benefits as some of the more strenuous types of exercise performed in a gym.

It is also important to remember that ‘strenuous’ exercise can take a toll on your joints. You might have been a good tennis player when you were 20 years old, but that was 20 years ago. Be nice to your knees so that if you live longer you don’t need painful surgery to get artificial knee joints to make your longer life more comfortable.

And yes, as a medical ‘wit’ once said, if you exercise regularly, you will live longer for exactly the amount of time you spend exercising. Also if you live long enough you might find that your spouse, your siblings and your best friends are all gone. And all you can do is think about them and miss them every time you go for a nice long walk.