Exercise -A Key to maintaining good Health: A Unani Perspective in The Modern Era: Narrative Review

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1 International Journal of Advances in Health Sciences (IJHS) ISSN Vol-4, Issue-1, 2017, pp Research Article Exercise -A Key to maintaining good Health: A Unani Perspective in The Modern Era: Narrative Review Khan Kahkashan Begam 1, Sikalgar Farha Rizwan 2, Rehan Safee 3, Shrikanth Muralidharan 4 and Javed Ali khan 5 1 P.G Scholars Department of Tahaffuzi wa Samaji Tib (PSM), 2 Associate Prof. Department of Tahaffuzi wa Samaji Tib (PSM), 3 HOD, Department of Tahaffuzi wa Samaji Tib (PSM), 4 Senior Lecturer, Department of Public Health Dentistry, 5 P.G Scholars Department of Tahaffuzi wa Samaji Tib (PSM) ZVM Unani Medical College &Hospital Pune. ABSTRACT- In ancient days, the word exercise (Riyazat) was defined only in medical books and common man was not aware of its health benefits, but in the era of modern medicine and social media, even a common man has become aware of the benefits of exercise and realized the value of it. Everybody is enthusiastic in knowing more about the benefits of exercise.lack of exercise has been identified as the fourth leading risk factor for global mortality (6% of deaths globally).riyazat has always been given the importance to maintain physical fitness and to avoid major health problems. It is also a primary and secondary level intervention as an adjunct to various systemic life- style related chronic diseases. Though it has been proved by many clinical trials that exercise can prevent from major lifestyle diseases, further research is needed to document the benefits of exercise especially in Unani system of medicine. Clinicians and patient must work together to maximize these benefits while minimizing risks for negative consequences. Identifying and preventing potential problems before hand can reduced adverse out come and promote this important approach to healthy living. We need greater Unani perspective intervention for the common man to benefit at large, since it is equally effective, irreversible (without any complications), can be adapted to easily, and the most important of all it is economically feasible. Key words- Riyazat, Unani, systemic illness, prevention, Ilaj bit Tadbeer INTRODUCTION In ancient days, the word exercise was defined only in medical books and common man was not aware of its health benefits, but in the era of modern medicine and social media, even a common man has become aware of the benefits of exercise and realized the value of it. Everybody is enthusiastic in knowing more about the benefits of exercise. Hence the primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role that physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic disease, example- cardiovascular disease, diabetes, and cancer, obesity and depression that could lead to a painful and premature death. 1 The beneficial effects of regular physical activity on health are indisputable in the field of modern medicine. Exercise is often the first step in

2 lifestyle modifications for the prevention and management of chronic diseases. According to a report by the US Department of Health and Human Services on physical activity, regular exercise significantly reduced the causes of mortality by up to 30% for men and women DHHS 2002 (Department of health and Human Services). 2 These health benefits are seen consistently across all age groups and racial/ ethnic categories. The centers for Disease Control and Prevention currently recommends 30 minutes of moderate to high-intensity exercise for at least 5 days a week for all healthy individuals(dhhs 2002). 2 What Is Physical Activity and Exercise? As per WHO (World Health Organization) physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure. Lack of exercise has been identified as the fourth leading risk factor for global mortality (6% of deaths globally). Moreover, physical inactivity is estimated to be the main cause for approximately 21 25% of breast and colon cancers, 27% of diabetes and approximately 30% of ischemic heart disease burden. Exercise, is a subcategory of physical activity that is planned, structured, repetitive, and purposeful in the sense that the improvement or maintenance of one or more components of physical fitness is the objective. Physical activity includes exercise as well as other activities which involve bodily movement and are done as part of playing, working, active transportation, house chores and recreational activities. Regular and adequate levels of physical activity in adults: 1. Reduce the risk of hypertension, 2. coronary heart disease, stroke, diabetes, breast and colon cancer, depression and the risk of falls; 3. Improve bone and functional health and 4. Are a key determinant of energy expenditure, and thus fundamental to energy balance and weight control. 3 Unani Perspective of Exercise The term exercise as in Unani system of medicine is known as Riyazat.As per Unani Physicians Ilaj bit Tadbeer, it is a basic part of the treatment. Ibn-E-Sina said that Exercise is the cause of good health if, it is done at the right time and in moderate quantity. 4,5 Riyazat (especially before meals) has always been given the importance to maintain physical fitness and to avoid major health problems. Riyazat is very much essential for the activation of Hararat-e Ghariziya (innate energy) and to eliminate the waste products of the body and it helps in preservation of health. There are two types of Riyazat in Unani Tibb(Unani Medicine): I.Riyazat-e-Arzia (Involuntary exercise) e.g. labour, agriculture. II.Riyazat- e-khalisa(voluntary exercise) Other types of Riyazat The exercise in Unani Medicine has been classified on the basis of rate, duration and intensity of exercise.the following types of exercises are described in the ancient texts of Unani: 1. Riyazat Qalila (Short duration exercise) 2. Riyazat Kaseera (Long duration exercise) 3. Riyazat Qawiya (Rigorous exercise) 4. Riyazat Zaeefa (Light exercise) 5. Riyazat Sareeaa (Quick exercise): is the exercise in which movements are performed rapidly. 6. Riyazat Bateeaa(Slow exercise) opposite of Sareeaa. 7. Riyazat Hasheesha (Quick and Rigorous exercise) 8. Riyazat Tarakhiya (Slow and light exercise). In Unani classical literature there are few more ways to do Riyazat for example walking, Khan Kahkashan Begam, et al. 8

3 swimming, mountaineering, boat rowing, horseriding andwrestling. 5 Benefits of Riyazat- The following advantages of Riyazat are mentioned in traditional classical books- 1. Exercise helps in excretion of toxic fluid in the body.it makes the body active and prevents fatigue and lethargy. 2. It helps in proper absorption of food and excretion of urine and fecal matters, melts the accumulated body fat. It produces energy and gives the musclesa tone through Hararat-e- Ghariziya. 3. It keeps the joints of the body in a healthy condition and makes ligaments and muscles strong. It also prevents the collection of toxic fluids in joints. 4. Regular exercise also plays an important role to reduce stress. All together Riyazat prevents diseases and keeps the humour of the body in balance. Uses of Riyazat in different diseases- According to Unani Physicians, Riyazat is beneficial in many diseases and Exercise can be used for the following diseases as a treatment alternative: 1 Diseases of brain: Sara (Epilepsy), Falij (Paralysis), Melancholia, Sehar (Insomnia). 2 Diseases of Gastro intestinal track: Indigestion, Colitis, Vomiting, Loss of appetite. Flatulence, Ascites. 3 Diseases of urinary system: Renal stone 4 Disease of Reproductive system: Leucorrhoea, Hysteria 5 Disease of Joints: Gout, Sciatica, Arthritis. 6 Riyazat can be either a primary or a secondary level intervention in the above systemic diseases. Exercise- Lifestyle related and fatal Diseases prevention: Heart Diseases and stroke Both men and women who reported increased levels of physical activity and fitness were foundto have reductions in relative risk (by about 20%-35%) of death. 7, 8 Several systematic reviews have mentioned the advantages of engaging in regular exercise to attenuate or reverse the diseases process in patients with cardiovascular diseases. For instance, a met-analysis of 48 clinical trials revealed that, compared with usual care, cardiac rehabilitation significantly reduced the incidence of premature death from any causes and from cardiovascular disease in particular. An energy expenditure of about 1600 kcal (6720kj) per week has been found to be effective in halting the progression of coronary artery disease, and an energy expenditure of about 2200 kcal (9240 kj) per week has been shown to be associated with atherosclerotic plaque reduction in patients with heart disease. 9,10 Diabetes Mellitus Exercise has both acute and chronic influences on patient with diabetes. Rapid changes in glucose concentration can occur during and post exercise. Before even routine exercise is recommended to patients a thorough understanding of acute changes in production and uptake of blood glucose is important. Exercise may play a cost effective role in potentially preventing cardio vascular complications; even delaying onset of type II diabetes. Both aerobic and resistance types of exercise have been shown to be associated with a decreased risk of type 2 diabetes. In a large prospective study,each increase of 500 kcal (2100 kj) in energy expenditure per week was associated with a decreased incidence of type 2 diabetes of 6% (relative risk 0.94, 95% CI 0.90 to 0.98). 11 Exercise interventions are also effective in the management of prevention of complications related to diabetes mellitus. A study by Gregg Khan Kahkashan Begam, et al. 9

4 and associates showed that walking at least 2 hours per week was associated with a reduction in the incidences of premature death of 39% 54% from any cause and of 34% 53% from cardiovascular disease among patients with diabetes. 12 Moreover, walking that leads to moderate increase in heart and breathing rates was associated with significant reductions in allcause mortality (hazard rate ratio 0.57, 95% CI 0.41 to 0.80) and cardiovascular-related mortality (hazard rate ratio 0.69, 95% CI 0.43 to 1.09).In another cohort study, physically inactive men with established type 2 diabetes had a 1.7 fold increased risk of premature death compared with physically active men with type 2 diabetes. 12 Cancer It appears that routine physical activity, whether as part of a job or as a leisure activity, is associated with reductions in the incidence of specific cancers, in particular colon and breast cancer. Physically active men and women exhibited a 30% 40% reduction in the relative risk of colon cancer, and physically active women a 20% 30% reduction in the relative risk of breast cancer compared with their inactive counterparts. 13,14 There is a paucity of information regarding the effectiveness of physical activity in preventing death from cancer or from any cause in patients with cancer. Regular physical activity appears to confer a health benefit to patients with established cancer. However, further research is warranted to examine its role in the secondary prevention of cancer. In particular, large RCTs evaluating the effectiveness of an exercise intervention are required to fully elucidate the importance of regular physical activity for the 15, 16 health status of patients with cancer. But nonetheless it is imperative for cancer survivors to maintain a healthy life style of which exercise is an important part. Though no studies exhibit any direct co-relation of benefits, still it definitely is an essential part of rehabilitation of these patients. Mental health Routine physical activity is also associated with improved psychological well-being (examplethrough reduced stress, anxiety and depression).psychological well-being is particularly important for the prevention and management of cardiovascular disease. 17 Recommendations Though it has been proved by many clinical trials that exercise can prevent from major lifestyle diseases further research is needed to document the benefits of exercise especially in Unani system of medicine. There should be proper guidelines and training with reference to classical Unani literature available in the books for exercises to treat and prevent lifestyle diseases, like cardiovascular diseases, diabetes mellitus, cancer and mental health problems especially by AYUSH in India. Public Health Perspective Successful community based interventions should be taken as a reflection of the application of the age old wisdom of Riyazat mentioned in Unani medical literature. Though today a lot of awareness is there, still not all can afford a professional trainer and the time for the same. The idea of this system is to prevent life style associated diseases that are a cause of major concern today. A definite system of spreading this Unani system far and wide is the need of the hour, focusing specially upon the more prudent and vulnerable lot of the society- the youngsters. With a fast life and junk food supported with neglect towards one s health, target specific trials and expert supervised sessions need to be implemented. CONCLUSION There appears to be a graded linear relation between the volume of physical activity and Khan Kahkashan Begam, et al. 10

5 health status, such that the most physically active people are at the lowest risk.most of the studies suggest that exercise is associated with better quality of life and health outcomes. Therefore, assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several population. The overall benefits of exercise are clearly significant. Clinicians and patient must work together to maximize these benefits while minimizing risks for negative consequences. Identifying and preventing potential problems before hand can reduced adverse out come and promote this important approach to healthy living. We need greater Unani perspective intervention for the common man to benefit at large, since it is equally effective, irreversible (without any complications), can be adapted to easily, and the most important of all it is economically feasible. REFERENCES: 1. Warburton DER, Nicol CW, Bredin SSD.2006;Health benefits of physical activity: the evidence.canadian Medical Association Journal, 174(6): Department of Health and Human Services.Physical activity fundamental to Preventing Diseases.Washington: U.S Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. 3. Global Strategy on Diet, Physical Activity and Health. WHO physical activity, Assessed on May 31 st 2016.htpp:// y/pa/en/ 4. Ibn E-Sina. 2010; Al Qanun Fil Tib. EjazPublishing House 2861,Kucha Chelan Darya Ganj, New Delhi, Vol I: page174, AlRaziRAMBZ(rhazes).February1991;KitabAl Mansoori(Urdutranslation)CCRUM,NewDelhi, page Kabiruddin M. Kuliyat-e- Nafeesi (Urdu). Idara Kitab-ul-Shifa 2075, Kucha Chelan Darya Ganj, New Delhi Vol I& II: page Macera CA,Hootman JM,Sniezek JE. 2003; Major public health benefits of physical activity. Arthritis Rheum. 49: Macera CA, Powell KE. 2001; Population attributable risk: implication of physical activity dose. Med Sci Sports Exercise 33: Hambrecht R, Niebauer J, Marburger C. 1993; Various intensities of leisure timephysical activity in patient with coronary artery diseases: Effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions; 22: Franklin BA, Swin DP, Shephard RJ 2003; New insights in prescription of exercise for coronary patients.j CardiovacNurs 18: Gregg EW,Gerzoff RB, Caspersen CJ, 2003; Relationship of walking to mortality among US adults with diabetes. Arch Intern Med, 344 (): Katzmarzyk PT, Church TS, Janssen I, 2005; Metabolic syndrome, obesity and mortality: impact of cardiorespiratory fitness. Diabetes Care 28: Lee IM. 2003; Physical activity and cancer prevention- data from epidemiologic studies. Med Sci Sports Exercise 35: Thune I, Furberg R. 2001; Physical activity and cancer risk: dose response and cancer, all sites and sites specific. Med Sci Sports Exercise 33:S Adammsen L, Midtgaard J, Rorth M, 2003; Feasibility,physical capacity, and health benefits of a multidimensional exercise program for cancer patients undergoing chemotherapy. Support Care Cancer, 110: Galvao D A, NewtonR U B.2005; Review of exercise intervention studies in cancer patients. J ClinOncol 230: s 17. Penedo FJ. Mar 2005; Exercise and well-being: a review of mental and physical health benefits associated with physical activity.curropin Psychiatry.18(2): SS Khan Kahkashan Begam, et al. 11