June 2017 | Issue 30


10,000 steps a day keep the doctor away

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By Sean Firoz, Senior Executive, Communications & External Relations 


In an effort to move more out of our sedentary lifestyle, we take time out of our schedule to exercise in they gym or
take a jog outside

We are moving less than ever before and it is making us sick. In fact, physical inactivity is now the fourth leading cause of death globally, according to a 2004 report by the World Health Organisation (WHO).

From good public infrastructure to electric scooters, and from emails and video conferences to smart home devices such as Apple's HomePod or Google Home, we enjoy an unprecedented level of convenience. So much so that many of us barely manage 10,000 steps a day, the target level of activity recommended by Singapore's Health Promotion Board (HPB).

But so what if we don't? We are already making healthier food choices, as stated in the 2015 Health & Wellness report from global survey company Nielsen, so surely we're off the hook? Not quite.

Sitting around gets you nowhere

The absence of exercise alters signals between the major organs in the body and the brain to maintain a certain degree of function that matches the demands of movements needed in daily and exercise routines. This creates a vicious downward spiral, where less movement leads to lower degree of function over time, which in turn reduces our capacity for exercise. Eventually, major organs such as the heart become weaker, the muscles reduce in size and strength and the density of bones become more porous. With ageing, some of these negative-adaptations due to inactivity can manifest in health conditions such as osteoporosis, metabolic disease and sarcopenia (a loss of muscle mass).

"That is how degeneration begins and over time, this leads to frailty, where our bones cannot withstand the impact of falling," said LKCMedicine Assistant Dean for Research and Associate Professor of Exercise Physiology Assoc Prof Fabian Lim.

Inactivity leads to reduced sensitivity to both glucose and insulin, increasing the risk of developing metabolic diseases such as diabetes in the long run. And while weight and lifestyle choices are risk factors, recent research has shown that even people whose weight is well within the healthy range may get diabetes too. 

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L-R: A showcase of how spirometry works during NTU's Open House 2017; Assoc Prof Fabian Lim gathers data on how physical activity interact with metabolic diseases in his laboratory

This is because a person of normal weight can be hiding a nearly undetectable type of body fat, and Asians are particularly susceptible to that. Known as visceral fat, it builds up around abdominal organs, triggering inflammation that affects the liver and pancreas, thereby contributing to insulin resistance.

But it is not just fat that makes us susceptible to diabetes. When we don't use our muscles, regulation of blood sugar (glucose) levels in the body is affected.

"When we exercise, muscles make the body more sensitive to insulin. This in turn makes them more efficient at absorbing sugar from the bloodstream. In addition, regular exercise increases muscles' capacity to absorb sugar, decreasing the risk of developing diabetes," said LKCMedicine Assistant Professor of Metabolic Disease Yusuf Ali.

And it is not just the risk of diabetes that is reduced. Sports medicine specialists like Dr Roger Tian, a senior consultant at Changi Sports Medicine Centre, no longer just care for athletes and military personnel with sports-related injuries, but increasingly see patients for whom taking up a safe exercise regime is a key strategy to prevent chronic health conditions.

Dr Tian said, "Exercise improves the function of cardiovascular, endocrine and metabolic systems in the body. For example, after an acute bout of exercise, the blood vessels are more compliant and blood pressure drops, so that helps for someone who is hypertensive."

Exercise even plays a role in diseases such as cancer. For example, a study conducted in 2005 has shown that regular exercise lowers levels of hormones that play a role in breast cancer such as oestrogen and insulin, reducing a woman's risk by approximately 50 per cent. Likewise for colon cancer, a study in 2002 on physical activity and colon cancer stated that exercise helps to lower the risk by over 60 per cent, as it alters the metabolism of bile acids, resulting in decreased exposure of the gastrointestinal tract to cancer-causing substances.

"Increased physical activity substantially increases sensitivity to insulin and reduces the risk of a cascade of diseases," said Imperial College London Director of the School of Public Health and a Principal Investigator for the Health for Life in Singapore Study (HELIOS) Professor Elio Riboli.

Assoc Prof Lim, who collaborates with Prof Riboli as a Co-Principal Investigator of the HELIOS study, added, "If exercise were a pill, it would be a multi-potent pill that can combat or prevent a wide range of health conditions."

Yet exercise often comes last on the list.


Changing our perception of exercise

In an effort to change this, Singapore's Ministry of Health has started to promote healthy living amongst Singaporeans of all ages. From events like the Healthy Lifestyle Festival SG in 2016 to giving free credits to access sports facilities through the ActiveSG programme, the aim is to encourage people to make small changes to their lifestyles, such as alighting a bus stop before their destination or taking the stairs instead of the lift.

In an attempt to kick-start such healthy habits, the HPB introduced several initiatives, including the National Steps Challenge in early 2016 to encourage Singaporeans to move 10,000 or more steps to win attractive prizes.

At the school and university-level, approaches to exercise are changing too. Secondary school physical education (PE) programmes are being replaced by sports science, which also provide insights into how the body works during exercise and building a well of knowledge about the movement and motor skills required to improve physical performance.

In April, NTU unveiled its new Sports Hall called The Wave, a one-stop venue for students to participate in sports activities and competitions.

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Located in NTU, The Wave provides a one-stop venue for students to come together and play sports
(source: NTU Hey! Magazine issue 30)

At the opening ceremony, Minister for National Development Mr Lawrence Wong lauded NTU for its efforts in advancing the science of sport and making it easy for students to maintain an active lifestyle, saying, "NTU provides pathways for young people who are interested in sports-related careers…and supports them in balancing their academic and sporting pursuits."

But what will be a good start for the average working adult to be up and about?

A great way to start exercising is to set aside three blocks of 10 minutes every day for some moderate physical activity, such as brisk walking or attending a class. This brings the weekly total up to an average of 150 minutes of exercise that in the long run can prevent chronic diseases, according to the American Heart Association.

And key to any new exercise regime is start slow and build up, giving the body ample time to adapt to a new activity, like training at least three to six months before attempting a marathon or triathlon for the first time. "It doesn't have to be vigorous, as long as you keep your heart rate up, that's enough, because at the end of the day, you want to get fit to play, not play to get fit," said Dr Tian.


Walking the talk

Knowing the science underpinning health and disease, our clinicians and researchers are walking the talk.

"I keep fit by doing things I love such as playing tennis, swimming and walking with my family on the weekends," said Asst Prof Yusuf.

Assoc Prof Lim added, "I try to have two to three sessions of planned exercise a week with a mix of cycling, brisk walking, jogging, gym and judo, depending on convenience and time."

While Dr Tian sets aside between three to five hours a week for different types of cardio exercise such as spinning and running. He added, "I also do one to two sessions of strength work and Pilates."

With the opening of the Clinical Sciences Building, which houses dedicated recreational facilities such as a dance hall and gym, other LKCMedicine staff, faculty and students, too, make an effort towards a healthier lifestyle.

"I started exercising mainly to relieve stress during my school days. However, after some time, I started enjoying exercise as part of my lifestyle, even feeling more refreshed after a simple jog," said LKCMedicine Human Resources Assistant Executive Nurul Syafiqah Binte Aniza.

After Team-Based Learning classes or studying in the library, students can be found working out at the School's gym or jogging around the NTU main campus' blue running track.

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Through various school activities, LKCMedicine students lead an active lifestyle both on campus and at home

"As I grow older I realise exercising helps in terms of physical and mental health, and it's a good complement when it comes to my studies, keeping physically fit and socialising with friends," said LKCMedicine Year 3 student Paul Vijo Poulose.

From school-level to nation-wide initiatives, Singapore has seen a growth of interest in exercise and these efforts are beginning to bear fruit. Over the last decade, the number of people who exercise frequently more than doubled to 38 per cent in 2014 from 16 per cent in 2001, according to Singapore Sports Index.

While most still cite a lack of time as the reason for not exercising, with more facilities, infrastructure and services opening, many more Singaporeans will find that is has become convenient to take that first step.