Development of Nation

January 5th, 2016

Development of Nation:

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Prologue:

When evolution of human species occurred, all humans all over the world were same. Most people have lost sight of the fact that a short time ago—very short in terms of the life span of the earth—people were nomadic food gatherers, garnering an existence as best they could from what nature threw their way. It has been only about 10,000 years since the Neolithic Agricultural Revolution, when people changed from food gatherers to food producers. Throughout most of subsequent human history, civilizations have been based on a comfortable life for a privileged minority and unremitting toil for the vast majority. Only within the past two centuries, ordinary people are able to expect leisure and high consumption standards, and that only in the world’s economically developed countries. The total major countries of the world are 188 out of which only 32 are developed and remaining 156 are developing. But why developed nations have higher standard of living, better health care, better education and better care of handicapped and elderly?  Is it because people of developed nation are more intelligent and more hard-working?  Is it because of geography, culture, policies, resources and colonisation?  I attempt to answer these questions knowing fully well that I am a student of science and not economics.

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Abbreviations and synonyms:

GDP = gross domestic product

GNP = gross national product

GNI = gross national income

LEDC = less economically developed country

LDC = least developed country

MEDC = more economically developed country

MDC = more developed country

NIC = newly industrialised country

LLDC = landlocked developing countries

OECD = organization of economic cooperation and development

HDI = human development index

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What is development?

Does development mean human development, economic development or economic development giving rise to human development?

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Human development:

The definition of development is fundamental to the comparison of developed and developing countries. The United Nations Development Program’s (UNDP) annual Human Development Report (HDR) defines human development as, “the expansion of people’s freedoms and capabilities to lead lives that they value and have reason to value. It is about expanding choices. Freedoms and capabilities are a more expansive notion than basic needs.” In other words, people in developing countries strive to move up the ladder of development in order both to meet basic needs and to have the opportunity to lead richer, more fulfilling lives. It is worth noting that this definition aligns development with more choice and may not be directly comparable to well-being or happiness, which can depend on social relationships and a variety of other factors. Human development – or the human development approach – is about expanding the richness of human life, rather than simply the richness of the economy in which human beings live. It is an approach that is focused on people and their opportunities and choices.

People:

Human development focuses on improving the lives people lead rather than assuming that economic growth will lead, automatically, to greater wellbeing for all. Income growth is seen as a means to development, rather than an end in itself.

Opportunities:

Human development is about giving people more freedom to live lives they value. In effect this means developing people’s abilities and giving them a chance to use them. For example, educating a girl would build her skills, but it is of little use if she is denied access to jobs, or does not have the right skills for the local labour market. Three foundations for human development are to live a long, healthy and creative life, to be knowledgeable, and to have access to resources needed for a decent standard of living. Once the basics of human development are achieved, they open up opportunities for progress in other aspects of life.

Choice:

Human development is, fundamentally, about more choice. It is about providing people with opportunities, not insisting that they make use of them. No one can guarantee human happiness, and the choices people make are their own concern. The process of development – human development – should at least create an environment for people, individually and collectively, to develop to their full potential and to have a reasonable chance of leading productive and creative lives that they value.

The human development approach remains useful to articulating the objectives of development and improving people’s well-being by ensuring an equitable, sustainable and stable planet.

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Development is a process where nations achieve higher standards of living, happiness and fulfilment often through economic growth. Development refers to developing countries working their up way up the ladder of economic performance, living standards, sustainability and equality that differentiates them from so-called developed countries. The point at which developing countries become “developed” comes down to a judgment call or statistical line in the sand that is often based on a combination of development indicators.  Development is a concept that is difficult to define; it is inevitable that it will also be challenging to construct development taxonomy. Countries are placed into groups to try to better understand their social and economic outcomes. The most widely accepted criterion is labelling countries as either developed or developing countries. There is no generally accepted criterion that explains the rationale of classifying countries according to their level of development. This might be due to the diversity of development outcomes across countries, and the restrictive challenge of adequately classifying every country into two categories.

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Economic development:

Economic development is a process whereby simple, low-income national economies are transformed into modern industrial economies. Although the term is sometimes used as a synonym for economic growth, generally it is employed to describe a change in a country’s economy involving qualitative as well as quantitative improvements. The theory of economic development—how primitive and poor economies can evolve into sophisticated and relatively prosperous ones—is of critical importance to underdeveloped countries, and it is usually in this context that the issues of economic development are discussed. Economic development first became a major concern after World War II. As the era of European colonialism ended, many former colonies and other countries with low living standards came to be termed underdeveloped countries, to contrast their economies with those of the developed countries, which were understood to be Canada, the United States, those of western Europe, most eastern European countries, the then Soviet Union, Japan, South Africa, Australia, and New Zealand. As living standards in most poor countries began to rise in subsequent decades, they were renamed the developing countries.

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There is no universally accepted definition of what a developing country is; neither is there one of what constitutes the process of economic development. Developing countries are usually categorized by a per capita income criterion, and economic development is usually thought to occur as per capita incomes rise. A country’s per capita income (which is almost synonymous with per capita output) is the best available measure of the value of the goods and services available, per person, to the society per year. Although there are a number of problems of measurement of both the level of per capita income and its rate of growth, these two indicators are the best available to provide estimates of the level of economic well-being within a country and of its economic growth. The economic development of a country or society is usually associated with (amongst other things) rising incomes and related increases in consumption, savings, and investment. Of course, there is far more to economic development than income growth; for if income distribution is highly skewed, growth may not be accompanied by much progress towards the goals that are usually associated with economic development.

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Economic development as an objective of policy:

The field of development economics is concerned with the causes of underdevelopment and with policies that may accelerate the rate of growth of per capita income. While these two concerns are related to each other, it is possible to devise policies that are likely to accelerate growth (through, for example, an analysis of the experiences of other developing countries) without fully understanding the causes of underdevelopment. Studies of both the causes of underdevelopment and of policies and actions that may accelerate development are undertaken for a variety of reasons. There are those who are concerned with the developing countries on humanitarian grounds; that is, with the problem of helping the people of these countries to attain certain minimum material standards of living in terms of such factors as food, clothing, shelter, and sanitation. For them, low per capita income is the measure of the problem of poverty in a material sense. The aim of economic development is to improve the material standards of living by raising the absolute level of per capita incomes. Raising per capita incomes is also a stated objective of policy of the governments of all developing countries. For policymakers and economists attempting to achieve their governments’ objectives, therefore, an understanding of economic development, especially in its policy dimensions, is important. Finally, there are those who are concerned with economic development either because they believe it is what people in developing countries want or because they believe that political stability can be assured only with satisfactory rates of economic growth. These motives are not mutually exclusive. Since World War II many industrial countries have extended foreign aid to developing countries for a combination of humanitarian and political reasons. Those who are concerned with political stability tend to see the low per capita incomes of the developing countries in relative terms; that is, in relation to the high per capita incomes of the developed countries. For them, even if a developing country is able to improve its material standards of living through a rise in the level of its per capita income, it may still be faced with the more intractable subjective problem of the discontent created by the widening gap in the relative levels between itself and the richer countries. (This effect arises simply from the operation of the arithmetic of growth on the large initial gap between the income levels of the developed and the underdeveloped countries. As an example, an underdeveloped country with a per capita income of $100 and a developed country with a per capita income of $1,000 may be considered. The initial gap in their incomes is $900. Let the incomes in both countries grow at 5 percent. After one year, the income of the underdeveloped country is $105, and the income of the developed country is $1,050. The gap has widened to $945. The income of the underdeveloped country would have to grow by 50 percent to maintain the same absolute gap of $900.) Although there was once in development economics a debate as to whether raising living standards or reducing the relative gap in living standards was the true desideratum of policy, experience during the 1960–80 period convinced most observers that developing countries could, with appropriate policies, achieve sufficiently high rates of growth both to raise their living standards fairly rapidly and to begin closing the gap.

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Harvard’s Lant Pritchett usefully defines development as a four-fold process of modernization, culminating in the following conditions in each:

1. Economic:  An economy characterized by high levels of productivity, typically dominated by large corporations with professional management.

2. Political:  A polity in which the citizens collectively constitute the state, which in turn exists legitimately only as an expression of their will.  It ensures universal equal treatment to all citizens by the state.

3. Administrative:  State functions are administered by a civil service bureaucracy characterized by merit-based recruitment, tenure in office not linked to personal or political patron, hierarchical structures, and performance through an impersonal application of rules.

4. Social:  All citizens perceive themselves and other citizens as members of a national community.

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Development indicators and its correlations:

Geographers use a series of development indicators to compare the development of one region against another. Geographers compare the statistics for different countries to see if there is a relationship or correlation between the data for different countries. A correlation helps to show what factors contribute to development. There is no single way to calculate the level of development because of the variety of economies, cultures and peoples.

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Measuring development:

Studying development is about measuring how developed one country is compared to other countries or to the same country in the past. Development measures show how economically, socially, culturally or technologically advanced a country is. The two most important ways of measuring development are economic development and human development.

•Economic development is a measure of a country’s wealth and how it is generated (for example agriculture is considered less economically advanced than banking).

•Human development measures the access the population has to wealth, jobs, education, nutrition, health, leisure and safety – as well as political and cultural freedom. Material elements, such as wealth and nutrition, are described as the standard of living. Health and leisure are often referred to as quality of life.

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Economic development indicators:

To assess the economic development of a country, geographers use economic indicators including:

•Gross Domestic Product (GDP) is the total value of goods and services produced by a country in a year.

•Gross National Product (GNP) measures the total economic output of a country, including earnings from foreign investments.

•GNP per capita is a country’s GNP divided by its population. (Per capita means per person.)

•Economic growth measures the annual increase in GDP, GNP, GDP per capita, or GNP per capita.

•Inequality of wealth is the gap in income between a country’s richest and poorest people. It can be measured in many ways, (e.g. the proportion of a country’s wealth owned by the richest 10 per cent of the population, compared with the proportion owned by the remaining 90 per cent).

•Inflation measures how much the prices of goods, services and wages increase each year. High inflation (above a few percent) can be a bad thing, and suggests a government lacks control over the economy.

•Unemployment is the number of people who cannot find work.

•Economic structure shows the division of a country’s economy between primary, secondary and tertiary industries.

•Demographics study population growth and structure. It compares birth rates to death rates, life expectancy and urban and rural ratios. Many LEDCs have a younger, faster-growing population than MEDCs, with more people living in the countryside than in towns. The birth rate in the UK is 11 per 1,000, whereas in Kenya it is 40.

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Human development indicators:

Development often takes place in an uneven way. A country may have a very high GDP – derived, for example, from the exploitation of rich oil reserves – while segments of the population live in poverty and lack access to basic education, health and decent housing. Hence the importance of human development indicators measuring the non-economic aspects of a country’s development.

Human development indicators include:

•Life expectancy – the average age to which a person lives, e.g. this is 79 in the UK and 48 in Kenya.

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The figure below shows life expectancy worldwide. In general, developed nations have higher life expectancy than developing nations.

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•Infant mortality rate – counts the number of babies, per 1000 live births, who die under the age of one. This is 5 in the UK and 61 in Kenya.

•Poverty – indices count the percentage of people living below the poverty level, or on very small incomes (e.g. under £1 per day).

•Access to basic services – the availability of services necessary for a healthy life, such as clean water and sanitation.

•Access to healthcare – takes into account statistics such as how many doctors there are for every patient.

•Risk of disease – calculates the percentage of people with diseases such as AIDS, malaria and tuberculosis.

•Access to education – measures how many people attend primary school, secondary school and higher education.

•Literacy rate – is the percentage of adults who can read and write. This is 99 per cent in the UK, 85 per cent in Kenya and 60 per cent in India.

•Access to technology – includes statistics such as the percentage of people with access to phones, mobile phones, television and the internet.

•Male/female equality – compares statistics such as the literacy rates and employment between the sexes.

•Government spending priorities – compares health and education expenditure with military expenditure and paying off debts.

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Determining Development by the UN:

To determine a country’s development, these statistics are usually considered by the United Nations:

1. GDP (Gross Domestic Product)

2. Life Expectancy

3. Literacy Rate

4. Education

5. Healthcare System

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Development Indicators can be qualitative and quantitative:

1. Quantitative Indicators – are based on objective and truthful pieces of information; and often collected in surveys or in a census.

2. Qualitative Indicators – are based on subjective feelings, impression and opinion. These provide a good indication of the social health of a country.

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Comparing Levels of Development:

Countries are unequally endowed with natural resources. For example, some countries benefit from fertile agricultural soils, while others have to put a lot of effort into artificial soil amelioration. Some countries have discovered rich oil and gas deposits within their territories, while others have to import most “fossil” fuels. In the past a lack or wealth of natural resources made a big difference in countries’ development. But today a wealth of natural resources is not the most important determinant of development success. Consider such high-income countries as Japan or the Republic of Korea. Their high economic development allows them to use their limited natural wealth much more productively (efficiently) than would be possible in many less developed countries. The productivity with which countries use their productive resources – physical capital, human capital, and natural capital – is widely recognized as the main indicator of their level of economic development. Theoretically, then, economists comparing the development of different countries should calculate how productively they are using their capital. But such calculations are extremely challenging, primarily because of the difficulty of putting values on elements of natural and human capital. In practice economists use gross national product (GNP) per capita or gross domestic product (GDP) per capita for the same purpose. These statistical indicators are easier to calculate, provide a rough measure of the relative productivity with which different countries use their resources, and measure the relative material welfare in different countries, whether this welfare results from good fortune with respect to land and natural resources or from superior productivity in their use.

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GDP, GNP and GNI:

Gross domestic product (GDP) is the total market value of all goods and services produced in the country, in a given year or quarter. GDP is equal to all government, consumer, and investment spending, plus the value of exports, minus the value of imports. GDP includes earnings made by foreigners while inside the country. GDP does not include earnings by its residents while outside of the country.

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Gross National Product (GNP) is the total market value of all goods and services produced by domestic residents. GNP includes domestic residents earnings from goods and services produced and sold abroad, and investments abroad. GNP does not include earnings by foreign residents while inside the country. GNP = GDP + Net property income from abroad. This net income from abroad includes, dividends , interest and profit.  GNP includes the value of all goods and services produced by nationals whether in the country or not.

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GNP measures the income of the people within the country whereas GDP measures economic activity in the country. If economic activity occurs in the country but the income from this activity accrues to foreigners, it will still be counted in GDP but not in GNP.

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There are two ways of calculating GDP and GNP:

•By adding together all the incomes in the economy – wages, interest, profits, and rents.

•By adding together all the expenditures in the economy- consumption, investment, government purchases of goods and services, and net exports (exports minus imports).

In theory, the results of both calculations should be the same. Because one person’s expenditure is always another person’s income, the sum of expenditures must equal the sum of incomes. When the calculations include expenditures made or incomes received by a country’s citizens in their transactions with foreign countries, the result is GNP. When the calculations are made exclusive of expenditures or incomes that originated beyond a country’s boundaries, the result is GDP. GNP may be much less than GDP if much of the income from a country’s production flows to foreign persons or firms. For example, in 1994 Chile’s GNP was 5 percent smaller than its GDP. If a country’s citizens or firms hold large amounts of the stocks and bonds of other countries’ firms or governments, and receive income from them, GNP may be greater than GDP. In Saudi Arabia, for instance, GNP exceeded GDP by 7 percent in 1994. For most countries, however, these statistical indicators differ insignificantly.

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Gross National Income (GNI) is GDP plus income paid into the country by other countries for such things as interest and dividends (less similar payments paid out to other countries).  The World Bank define GNI as the sum of value added by all resident producers plus any product taxes (minus subsidies) not included in the valuation of output plus net receipts of primary income (compensation of employees and property income) from abroad. In this respect, GNI is quite similar to GNP, which measures output from the citizens and companies of a particular nation, regardless of whether they are located within its boundaries or overseas. The World Bank now uses GNI rather than GNP.

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Per capita income:

GDP and GNP can serve as indicators of the scale of a country’s economy. But to judge a country’s level of economic development, these indicators have to be divided by the country’s population. GDP per capita and GNP per capita show the approximate amount of goods and services that each person in a country would be able to buy in a year if incomes were divided equally. That is why these measures are also often called “per capita incomes.”

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North America, Western Europe and Australia show highest GDP per capita.

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Limitation of per capita income:

It’s important to remember that GDP and GNP are measures of the big picture of a nation’s economy. As a result, there are statistics closer to home that don’t match up with GDP/GNP, particular when we look at per capita figures.

1. Personal income.

Per Capita GDP in the US is $49,922 for 2012. This should not be confused with anything resembling average income! Per capita GDP is simply the GDP divided by the population of the country. It is not an average wage. According to the Social Security Administration, the average wage was closer to $43,000 in 2012.

2. Income distribution.

We can look at GDP/GNP numbers to determine the overall economic strength of a given nation, but that number does not indicate the income distribution within the country. A nation could have a relatively high GDP/GNP, or a high per capita GDP/GNP because it has a small number of very large industries (typical of oil producing countries). In this way, high GDP/GNP numbers could mask the fact that the majority of people in a country are relatively poor.

3. Living conditions:

Because per-capita income is the overall income of a population divided by the number of people included in the population, it does not always give an accurate representation of the quality of life due to the function’s inability to account for skewed data. For instance, if there is an area where 50 people are making $1 million per year and 1,000 people making $100 per year the per capita income is $47,714, but that does not give a true picture of the living conditions of the entire population.

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Nominal vs. Purchasing Power Parity (PPP):

The lack of comparable reporting from one country to another has given rise to two methods of computing either GDP or GNP, nominal and purchasing power parity, or PPP. Nominal is measuring the size of a nation’s economy on the basis of its economy in local currency, converted to dollars (typically). The conversion is based on currency exchange rates in the currency market. PPP ignores currency exchange rates, and measures the economy of countries based on the cost of a common basket of goods and services. The amount of goods and services one can purchase depends on two things: income and the price level. Same amount of income buys fewer goods and services if prices are high compared to the case when prices are low. This implies that if we ignore differences in price level across countries, then just the comparison of per-capita income across countries can give misleading picture of differences in the standards of living. It turns out that on average prices in developing countries are lower than prices in developed countries. One dollar spent in India buys more goods and services than in the United States. The main reason for lower prices in developing countries is relatively low labor cost. Researchers have tried to take into account such price differences across countries and developed the concept of purchasing power parity (PPP). PPP is calculated using a common set of international prices for all goods and services produced, valuing goods in all countries at U.S. prices. PPP is defined as the number of units of a foreign country’s currency required to purchase the identical quantity of goods and services in the local markets as $1 would buy in the United States. GNP in PPP terms thus provides a better comparison of average income or consumption between economies.  In developing countries real GNP per capita is usually higher than nominal GNP per capita, while in developed countries it is often lower. Thus the gap between real per capita incomes in developed and developing countries is smaller than the gap between nominal per capita incomes.

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Nominal and real GNP per capita in various countries, 1999

GNP per capita
(US Dollars)
GNP per capita
(PPP Dollars)
India
China
Russia
Brasil
USA
Germany
Japan
340
620
2,245
3,640
26,980
27,510
39,640
1,400
2,920
4,480
5,400
26,980
20,070
22,110

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North America, Western Europe, Australia and Gulf-states show highest GDP-PPP per capita.

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The figure above shows wide gap in GDP per capita between developed and developing nations over last three decades.

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Limitations of GDP/GNP/GNI:

Gross domestic product (GDP) is the magical term often used to describe the economic growth of a country. Governments, experts and news reports point to it as a measure of progress. In development, a field often dominated by economists, GDP is all but an obligatory part of the discussion when it comes to country level progress. The problem is many other experts say GDP is actually not very good at measuring either progress or development.  Nobel Prize winning economist Joseph Stiglitz is among the most vocal opponents of overusing GDP as a yardstick for development. He says that it does not capture equally important issues like poverty levels and inequality. The overall economies of countries can hum along for years showing solid GDP growth without meaningful change for the majority of its citizens. One need not look further than the US to see how middle class incomes have held steady over the past few decades, despite overall GDP growth and wealth accumulation at the top.  Although they reflect the average incomes in a country, GNP per capita and GDP per capita have numerous limitations when it comes to measuring people’s actual well-being. They do not show how equitably a country’s income is distributed. They do not account for pollution, environmental degradation, and resource depletion. They do not register unpaid work done within the family and community, or work done in the shadow economy. And they attach equal importance to “goods” (such as medicines) and “bads” (cigarettes, chemical weapons) while ignoring the value of leisure and human freedom. Thus, to judge the relative quality of life in different countries, one should also take into account other indicators showing, for instance, the distribution of income and incidence of poverty, people’s health and longevity, access to education, the quality of the environment, and more. Experts also use composite statistical indicators of development.

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Other limitations of GDP:

Non-market transactions – GDP excludes activities that are not provided through the market, such as household production and volunteer or unpaid services. As a result, GDP is understated.

Underground economy – Official GDP estimates may not take into account the underground economy, in which transactions contributing to production, such as illegal trade and tax-avoiding activities, are unreported, causing GDP to be underestimated.

Non-monetary economy – GDP omits economies where no money comes into play at all, resulting in inaccurate or abnormally low GDP figures.

Sustainability of growth – GDP does not measure the sustainability of growth. A country may achieve a temporarily high GDP by over-exploiting natural resources or by misallocating investment.

One main problem in estimating GDP growth over time is that the purchasing power of money varies in different proportion for different goods, so when the GDP figure is deflated over time, GDP growth can vary greatly depending on the basket of goods used and the relative proportions used to deflate the GDP figure

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A development index measures a country’s performance according to specific development indicators. Some countries may appear to be developed according to some indices, but not according to others.

Vietnam and Pakistan:

Both countries have a similar per capita GDP. However, life expectancy and literacy are considerably higher in Vietnam than they are in Pakistan.

Saudi Arabia and Croatia:

Saudi Arabia has a per capita GDP comparable to that of Croatia. However, in Saudi Arabia there is greater inequality between men and women when considering access to education and political power. So, although they are equal on an economic development index – Saudi Arabia is less developed on a human development index.

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Problems with indices:

Development indices can be misleading and need to be used with care. For example:

•Many indices are averages for the whole population of a country. This means that indices do not always reveal substantial inequalities between different segments of society. For example, a portion of the population of a highly developed country could be living below the poverty line.

•In some countries, the data used in indices could be out of date or hard to collect. Some countries do not wish to have certain index data collected – for example, many countries do not publish statistics about the number of immigrants and migrants.

To balance inaccuracies, indices tend to be an amalgamation of many different indicators. The United Nations Human Development Index (HDI) is a weighted mix of indices that show life expectancy, knowledge (adult literacy and education) and standard of living (GDP per capita). As Vietnam has a higher literacy rate and life expectancy than Pakistan, it has much higher HDI value even though it has a similar per capita GDP.

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HDI:

The United Nations Development Programme’s (UNDP) Human Development Index (HDI) is probably the most widely recognized tool for measuring development and comparing the progress of developing countries. The HDI scores and ranks each country’s level of development based on three categories of development indicators: income, health and education. The Human Development Index is a composite statistics of life expectancy, education, and income per capita indicators, which are used to rank countries into four tiers of human development. The human development report (HDR) classifies countries into four levels of development based on their HDIs: “very high human development,” “high human development,” “medium human development” and “low human development.” Each level of development is generally accompanied by higher income, longer life expectancy and more years of education, which combine to provide people with more capabilities, freedoms and choices. Over half of the world’s population live in countries with “medium human development” (51%), while less than a fifth (18%) populate countries falling in the “low human development” category. Countries with “high” to “very high” human development account for slightly less than a third of the world’s total population (30%). From 2007 to 2010, the first category was referred to as developed countries, and the last three are all grouped in developing countries. The 2010 Human Development Report introduced an Inequality-adjusted Human Development Index (IHDI). While the simple HDI remains useful, it stated that “the IHDI is the actual level of human development (accounting for inequality),” and “the HDI can be viewed as an index of ‘potential’ human development (or the maximum IHDI that could be achieved if there were no inequality).”. HDI is measured between 0 and 1. A HDI between 1 and 0.8 is considered high, 0.8 and 0.6 is considered medium and 0.6 to 0.4 is considered low. The USA has an HDI of 0.994 whereas Kenya has an HDI of 0.474.

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Human Development Report (HDR) combines three dimensions:

•A long and healthy life: Life expectancy at birth

•Education index: Mean years of schooling and Expected years of schooling

•A decent standard of living: GNI per capita (PPP US$)

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What does the Human Development Index tell us?

The Human Development Index (HDI) was created to emphasize that expanding human choices should be the ultimate criteria for assessing development results. Economic growth is a mean to that process, but is not an end by itself. The HDI can also be used to question national policy choices, asking how two countries with the same level of GNI per capita can end up with different human development outcomes. For example, Malaysia has GNI per capita higher than Chile, but in Malaysia, life expectancy at birth is about 7 years shorter and expected years of schooling is 2.5 years shorter than Chile, resulting in Chile having a much higher HDI value than Malaysia. These striking contrasts can stimulate debate about government policy priorities.

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Can GNI per capita be used to measure human development instead of the HDI?

No. Income is a means to human development, and not the end. The GNI per capita only reflects average national income. It does not reveal how that income is spent, nor whether it translates to better health, education and other human development outcomes. In fact, comparing the GNI per capita rankings and the HDI rankings of countries can reveal much about the results of national policy choices. Gabon with a GNI per capita of $16,367 (PPP$) has a GNI rank of 68, but an HDI rank 110 – the same as that of Indonesia whose GNI per capita is only $9,788 (PPP$).

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Life expectancy at birth: Number of years a newborn infant could expect to live if prevailing patterns of age-specific mortality rates at the time of birth stay the same throughout the infant’s life.

Expected years of schooling: Number of years of schooling that a child of school entrance age can expect to receive if prevailing patterns of age-specific enrolment rates persist throughout the child’s life.

Mean years of schooling: Average number of years of education received by people ages 25 and older, converted from education attainment levels using official durations of each level.

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In its 2010 Human Development Report, the UNDP began using a new method of calculating the HDI. The following three indices are used:

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The health dimension is assessed by life expectancy at birth component of the HDI is calculated using a minimum value of 20 years and maximum value of 85 years. The education component of the HDI is measured by mean of years of schooling for adults aged 25 years and expected years of schooling for children of school entering age. Expected years of schooling is capped at 18 years. The indicators are normalized using a minimum value of zero and maximum aspirational values of 15 and 18 years respectively. The two indices are combined into an education index using arithmetic mean. The standard of living dimension is measured by gross national income per capita. The goalpost for minimum income is $100 (PPP) and the maximum is $75,000 (PPP). The minimum value for GNI per capita, set at $100, is justified by the considerable amount of unmeasured subsistence and nonmarket production in economies close to the minimum that is not captured in the official data. The HDI uses the logarithm of income, to reflect the diminishing importance of income with increasing GNI. The scores for the three HDI dimension indices are then aggregated into a composite index using geometric mean. HDI ranges from a theoretical minimum of zero (for a life expectancy = 25 years, complete illiteracy and a GDP per capita = $100 at purchasing power parity) to a theoretical maximum of one (for a life expectancy = 85 years, 100% literacy and a GDP per capita = $40,000 at purchasing power parity). In practice, the observed range is 0.3 – 0.97. The HDI simplifies and captures only part of what human development entails. It does not reflect on inequalities, poverty, human security, empowerment, etc.

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Why is geometric mean used for the HDI rather than the arithmetic mean?

In 2010, the geometric mean was introduced to compute the HDI. Poor performance in any dimension is directly reflected in the geometric mean. That is to say, a low achievement in one dimension is not anymore linearly compensated for by high achievement in another dimension. The geometric mean reduces the level of substitutability between dimensions and at the same time ensures that a 1 percent decline in index of, say, life expectancy has the same impact on the HDI as a 1 percent decline in education or income index. Thus, as a basis for comparisons of achievements, this method is also more respectful of the intrinsic differences across the dimensions than a simple average.

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Why is the HDI using the logarithm of income component?

In addition to capping, the income enters the HDI as a logarithmically transformed variable. The idea is to emphasize diminishing marginal utility of transforming income into human capabilities. This means that the concave logarithmic transformation brings closer the notion that an increase of GNI per capita by $100 in a country where the average income is only $500 has a much greater impact on the standard of living than the same $100 increase in a country where the average income is $5,000 or $50,000.

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HDI 2014:

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Criticism of HDI:

The Human Development Index has been criticized on a number of grounds including alleged ideological biases towards egalitarianism and so-called “Western models of development”, failure to include any ecological considerations, lack of consideration of technological development or contributions to the human civilization, focusing exclusively on national performance and ranking, lack of attention to development from a global perspective, measurement error of the underlying statistics, and on the UNDP’s changes in formula which can lead to severe misclassification in the categorisation of ‘low’, ‘medium’, ‘high’ or ‘very high’ human development countries. Given its focus on basic education and health measures, the HDI is most relevant in countries with low or medium human development. Just as the Millennium Development Goals have been a galvanizing force for efforts to support the world’s poorest countries, the HDI is a useful benchmark for such countries. However, it lacks a broader set of measures to guide progress once basic levels of need have been addressed. As a result there is little variation in scores amongst high-income countries. Though the HDI covers 187 countries, the limited range of indicators mean that its descriptive and explanatory value is limited for upper middle and high income countries.

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Can the HDI alone measure a country’s level of human development?

No. The concept of human development is much broader than what can be captured by the HDI, or by any other composite index in the Human Development Report (Inequality-adjusted HDI, Gender development index, Gender Inequality Index and Multidimensional Poverty Index). The composite indices are a focused measure of human development, zooming in on a few selected areas. A comprehensive assessment of human development requires analysis of other human development indicators and information presented in the statistical annex of the report (see the Readers guide to the Report).

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Multidimensional Poverty Index (MPI):

Like development, poverty is multidimensional — but this is traditionally ignored by headline money metric measures of poverty. The Multidimensional Poverty Index (MPI), published for the first time in the 2010 Report, complements monetary measures of poverty by considering overlapping deprivations suffered at the same time. The index identifies deprivations across the same three dimensions as the HDI and shows the number of people who are multi-dimensionally poor (suffering deprivations in 33% or more of weighted indicators) and the number of deprivations with which poor households typically contend with. It can be deconstructed by region, ethnicity and other groupings as well as by dimension, making it an apt tool for policymakers.  The MPI can help the effective allocation of resources by making possible the targeting of those with the greatest intensity of poverty; it can help address MDGs strategically and monitor impacts of policy intervention. The MPI can be adapted to the national level using indicators and weights that make sense for the region or the country, it can also be adopted for national poverty eradication programs, and it can be used to study changes over time. Almost 1.5 billion people in the 101 developing countries covered by the MPI—about 29 percent of their population — live in multidimensional poverty — that is, with at least 33 percent of the indicators reflecting acute deprivation in health, education and standard of living. And close to 900 million people are vulnerable to fall into poverty if setbacks occur – financial, natural or otherwise.

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GDP vs. HDI:

While GDP and HDI may seem different with HDI being considered more advanced than GDP, which it technically is, GDP and HDI according to Hans Rosling are actually quite similar and tell similar results. In his own words: “There is today a very strong correlation between GDP/capita and HDI as seen from the graph above. If you exclude 6 countries on the right side of the strong correlation that have higher GDP/capita than HDI due to oil or diamonds; and if you exclude 6 former Soviet Republics with collapsed economy but still high literacy rate on the left side of the correlation; you will find that the GDP/capita and the value on Human Development Index follow each other very closely from the worst-off country Congo to the best-off country Norway. The reason seems to be that nations today are surprisingly capable in converting the available national income (measured as GDP/capita) into a longer lifespan for the people (measured as Life expectancy at birth) and into access to education (measured by mean of years of schooling for adults aged 25 years and expected years of schooling for children of school entering age).  But the reason may also be that nations today are very good at converting improved health and education into economic growth. Most probably the causality goes in both directions.  If you want better health and education fix economic growth. If you want faster economic growth provide better education and health service. GDP/capita appears to be as good a measure of progress of nations as are HDI. This is because with high GDP, the government and the people have more money to spend on education and health care. Vice versa, with better education and health service comes faster economic growth, because now people are healthier meaning more likely to work and as they have better education they are more likely to further themselves in their field earning more money. But, the analysis for different income group of countries suggests that the positive relationship between GDP and HDI is more prominent for the low income countries and weakens for the middle and high income countries in all the years.

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Economic Growth and Life Expectancy:

The relationship between income and life expectancy has been demonstrated by a number of statistical studies. The so-called Preston curve, for example, indicates that individuals born in wealthier countries, on average, can expect to live longer than those born in poor countries. It is not the aggregate growth in income, however, that matters most, but the reduction in poverty. The most obvious explanation behind the connection between life expectancy and income is the effect of food supply on mortality. Historically, there have been statistically convincing parallels between prices of food and mortality. Higher income also implies better access to housing, education, health services and other items which tend to lead to improved health, lower rates of mortality and higher life expectancy. It is not surprising therefore that aggregate income has been a pretty good predictor of life expectancy historically. However correlation does not necessarily imply causality running from income to health. It could actually be that better health, as proxied by life expectancy, contributes to higher incomes, rather than vice versa. Better health can increase incomes because healthier individuals tend to be more productive than sick ones; on average they work harder, longer and are more capable of focusing efficiently on production tasks.  Furthermore, better health may affect not just the level of income but also its growth rate through its effect on education. Healthier children spend more time at school and learn faster, thus acquiring more human capital which translates into higher growth rates of incomes later in life.

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Preston curve:

 

The x-axis shows GDP per capita in 2005 international dollars, the y-axis shows life expectancy at birth. Each dot represents a particular country. The Preston curve indicates that individuals born in richer countries, on average, can expect to live longer than those born in poor countries. However, the link between income and life expectancy flattens out. This means that at low levels of per capita income, further increases in income are associated with large gains in life expectancy, but at high levels of income, increased income has little associated change in life expectancy. In other words, if the relationship is interpreted as being causal, then there are diminishing returns to income in terms of life expectancy.

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Literacy:

Literacy is the ability to read and write with understanding in any language. This is a definition which closely matches the UNESCO’s definition.

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Why Education Matters:

Education is the single best investment in prosperous, healthy and equitable societies. No country has ever achieved rapid and continuous economic growth without at least a 40% literacy rate. In sub-Saharan Africa, 1 in 4 children does not attend school; of those who attend, 1 in 3 will drop out before completing primary school. Worldwide, 69 million children are not in school; of those, 60% are girls. A single year of primary school increases a boy’s future earning potential by five to 15% and a girl’s even more. A child born to a literate mother is 50% more likely to survive past the age of five. Education provides a direct path towards food security and out of poverty. Education and food security are directly connected: doubling primary school attendance among impoverished rural children can cut food insecurity by up to 25. Educated parents are able to earn an income, produce more food through agricultural initiatives, and feed their children. Children who complete primary education are more likely to achieve food security as adults and end the cycle of poverty in their generation. Education leads to improved social, cognitive and health outcomes. Education increases people’s confidence, enabling them to become self-sufficient, fully contributing members of their communities. Education leads to gender equality and equity – girls and women who achieve higher levels of education are greater contributors to overall economic development and to children’s welfare within communities. Achieving educational equity for girls – including educating communities on the value of girls’ education – is an essential factor in sustainable poverty alleviation. Education is the single-most important driver of economic empowerment for individuals and countries.

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Literacy and economic growth:

Literacy is always considered to be an important key for socio-economic growth. Economic prosperity of a country entirely depends on the economic resources it has and human resource is an important part of economic resource. Human resource includes the population, its growth rate, skills, standard of living and the working capacity of the labor force and all the above factors can be enhanced by increasing the literacy rate of a population. Thus literacy rate plays a key role in economic growth of a country. Japan can be an example where an economy has developed by excelling in human resources despite the deficiency of natural resource. As the biggest asset India has is its human resource, effective utilization of the human resource becomes very crucial for the country’s economic progress and thus literacy plays all the more an important role in determining India’s growth. Just being literate does not make people competent enough to enter the labor force in the market. Moreover enhancing additional supplementary skills is a necessity in an economy which has a lot of structural unemployment. It will reduce the occupational immobility of labor and will also improve the employability of the labor supply. Unskilled labors are seasonally employed, mainly in agricultural fields, and paid minimal wages. Imbibing skills in these workers will ensure them more permanent jobs and higher wage rates. Agricultural sector, which employs more than 50% of the workforce in India, is highly unproductive. Imbibing technical skills in these workers will enable them to work in productive, decent-wage jobs in industries. Thus enabling better utilization of human capital and making most of the human resource. Because we have lacked direct measures for ‘skills,’ indicators of educational attainment have typically been used as a proxy measure, with educational attainment being measured either as years of schooling or as highest level of education completed, ranging from less than high school to having one or more university degrees. Friedrich Huebler (2005) shows the correlation between GDP per capita and education by plotting the school net enrolment ratios (NER) against GDP per capita of 120 different countries. Higher the income levels of a country, higher the levels of school enrolment. However, these indirect indicators cannot distinguish between the acquisition of specific knowledge versus general literacy skills. The development of new surveys that allow ‘skill’ to be measured more directly have permitted researchers to tackle these issues. One such survey is the International Adult Literacy Survey (IALS) which provides measures of directly-assessed literacy skills for the population aged 16 to 65 years for twenty-three OECD countries.  A recent study used data from IALS to investigate the relationship between educational attainment, literacy skills and economic growth. That study found that investment in human capital, that is, in education and skills training, is three times as important to economic growth over the long run as investment in physical capital, such as machinery and equipment. The results also show that direct measures of human capital based on literacy scores perform better than years-of-schooling indicators when explaining growth in output per capita and per worker.  One of the study’s key conclusions is that human capital accumulation matters a great deal for the long-run wellbeing of nations. In fact, the study suggests that differences in average skill levels among OECD countries explain fully 55% of the differences in economic growth over the 1960 to 1994 period. This implies that investments in raising the average level of skills could yield large economic returns.  Furthermore, the study finds that the average literacy score in a given population is a better indicator of growth than one based solely on the percentage of the population with very high literacy scores. In other words, a country that focuses on promoting strong literacy skills widely throughout its population will be more successful in fostering growth and wellbeing than one in which the gap between high-skill and low-skill groups is large.  Also using data from IALS, Green and Riddell focused their research on individuals, rather than countries, to determine the relative contributions of education and literacy skills to earnings levels. Green and Riddell found that each additional year of education raises earnings by approximately 8%.

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The Relationship between Literacy Rate and GDP per Capita:

There is sufficient evidence to conclude that there is a positive relationship between literacy rate and the log of GDP per capita for all world countries. The graph above shows a clear positive correlation between adult literacy and GDP per capita. Developed countries such as the USA and the United Kingdom have high literacy rates as well; poorer countries such as Sierra Leone and Liberia have lower literacy rates as well. From another observational study, authors conclude that there is a positive, exponential relationship between literacy rate and GDP per capita of world countries. This means that as literacy rate increases, so does GDP per capita.

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Western developed nations had high literacy rate even in the year 1800 and even that time GDP per capita was higher in them compared to developing nations.

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Literacy and population growth:

When a study of India’s population growth is done over the past century, it depicts a typical case of classical theory of demographic transition. According to the classical demographic transition model, a country undergoes a transition from high birth and death rates to low birth and death rates as it develops from a pre-industrial to an industrialized economic system. The population of India in 1901 was 238 million with a density of 77 per sq km, from 1901-1921 India almost had a stagnant population. The period 1921-1951 saw India having a steady growth rate but from 1951-1981 the country underwent a rapid high growth in population with growth rate averaging around 19%. From 1981-2001 India faced high growth with definite slowing down. The latest census data of 2011 also shows this slowing down as India’s population grew at a rate of 17.64% in the past decade. India has successively passed through all the phases of demographic transition and is now widely believed to have entered the fifth phase, characterized by rapidly declining fertility. When the total fertility rate (TFR) data of past 50 years is considered, it has come down from 5.9 in 1960 to 2.65 in 2010. If literacy rate in the same period is considered, India had a literacy rate of mere 6% in 1901. It has been on an increase ever since. After independence schooling was made free and compulsory for children aged between 6 and 14 under the Right to Education Act. If data of past 50 years is considered, literacy rate has increased from 28.31% in 1961 to 74.04% in 2011. So if one notices there has been an increase in the literacy rate and a decrease in TFR. Studies show a very strong negative correlation between literacy rate and TFR and thus a strong reduction in population growth rate with an increase in literacy.

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Education to reduce fertility rate:

Fertility rates tend to be highest in the world’s least developed countries. When mortality rates decline quickly but fertility rates fail to follow, countries can find it harder to reduce poverty. Poverty, in turn, increases the likelihood of having many children, trapping families and countries in a vicious cycle. Conversely, countries that quickly slow population growth can receive a “demographic bonus”: the economic and social rewards that come from a smaller number of young dependents relative to the number of working adults. For longer term population stability the goal is to reach replacement-level fertility, which is close to 2 children per woman in places where mortality rates are low. Industrial countries as a group have moved below this level. Some developing countries have made progress in reducing fertility, but fertility rates in the least developed countries as a group remain above 4 children per woman.  One of the most effective ways to lower population growth and reduce poverty is to provide adequate education for both girls and boys. Countries in which more children are enrolled in school—even at the primary level—tend to have strikingly lower fertility rates.

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Primary School Enrolment and Total Fertility Rates for Selected Countries:

Rank Country Primary School Enrolment Total Fertility Rate
Percent Number of children
per woman
1 Japan 100.0 1.3
2 Spain 99.8 1.5
3 Iran 99.7 1.8
4 Georgia 99.6 1.6
5 United Kingdom 99.6 1.9
181 Equatorial Guinea 53.5 5.3
182 Guinea-Bissau 52.1 5.7
183 Djibouti 40.1 3.9
184 Sudan 39.2 4.2
185 Eritrea 35.7 4.6

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Female education is especially important. Research consistently shows that women who are empowered through education tend to have fewer children and have them later. If and when they do become mothers, they tend to be healthier and raise healthier children, who then also stay in school longer. They earn more money with which to support their families, and contribute more to their communities’ economic growth. Indeed, educating girls can transform whole communities. School meal programs help improve all children’s attendance in low-income countries, but for girls the benefit is profound. Girls are more likely to be expected to contribute to their families by working at home, so sending each additional girl to school may cost her family not only tuition but labor as well. Providing free meals at school helps to offset these costs, particularly when programs include take-home rations. As a result, girls are both more likely to go to school and to keep coming back year after year. This is significant because girls who reach secondary school are especially likely to have fewer children. Worldwide, 69 million elementary-school-aged children were not in school in 2008, 37 million fewer than in 1999. By 2005, almost two thirds of developing countries had achieved gender parity in elementary school enrolment. Still, a majority of children not in school are female, and early marriage and motherhood keep many of the world’s poorest girls from completing secondary school.  Extending educational opportunities to all the world’s children can clearly reap vast rewards in lower population growth—which in turn brings greater stability, prosperity, and environmental sustainability.

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Fertility and economic growth:

Contrary to the idea of population growth having an impact on economic growth, it can be more confidently put that economic growth does impact the population growth and slows it down. When the fertility rate in 171 countries was plotted against the GNI (Gross National Income) by Philip N. Cohen in 2009, the graph, shown below, was showing lower fertility rates with nations with higher GNI than the nations with lower GNI. This can be inferred to as declining fertility rates for an economy with increasing growth.

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Demographic-economic paradox:

The demographic-economic “paradox” is the inverse correlation found between wealth and fertility within and between nations. The higher the degree of education and GDP per capita of a human population, subpopulation or social stratum, the fewer children are born in any industrialized country. In a 1974 UN population conference in Bucharest, Karan Singh, a former minister of population in India, illustrated this trend by stating “Development is the best contraceptive.” The term “paradox” comes from the notion that greater means would enable the production of more offspring as suggested by the influential Thomas Malthus.  Roughly speaking, nations or subpopulations with higher GDP per capita are observed to have fewer children, even though a richer population can support more children. It is hypothesized that the observed trend has come about as a response to increased life expectancy, reduced childhood mortality, improved female literacy and independence, and urbanization that all result from increased GDP per capita, consistent with the demographic transition model.  A reduction in fertility can lead to an aging population which leads to a variety of problems.  Some scholars have recently questioned the assumption that economic development and fertility are correlated in a simple negative manner. A study published in Nature in 2009 has found that when using the Human Development Index instead of the GDP as measure for economic development, fertility follows a j-shaped curve: with rising economic development, fertility rates indeed do drop at first, but then begin to rise again as the level of social and economic development increases, while still remaining below the replacement rate.

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Correlation between indices for development:

The figure above shows that education is the single most important factor promoting development of a nation and population explosion is the single most important factor hampering development of a nation.

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Standard of living:

How do you define “standard of living”?

The World Bank says:

Standard of living is the level of well-being (of an individual, group or the population of a country) as measured by the level of income (for example, GNP per capita) or by the quantity of various goods and services consumed (for example, the number of cars per 1,000 people or the number of television sets per capita).

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Standard of living is the level of wealth, comfort, material goods and necessities available to a certain socioeconomic class in a certain geographic area. The standard of living includes factors such as income, quality and availability of employment, class disparity, poverty rate, quality and affordability of housing, hours of work required to purchase necessities, gross domestic product, inflation rate, number of vacation days per year, affordable (or free) access to quality healthcare, quality and availability of education, life expectancy, incidence of disease, cost of goods and services, infrastructure, national economic growth, economic and political stability, political and religious freedom, environmental quality, climate and safety. The standard of living is closely related to quality of life. The standard of living is often used to compare geographic areas, such as the standard of living in the United States versus Canada, or the standard of living in St. Louis versus New York. The standard of living can also be used to compare distinct points in time. For example, compared with a century ago, the standard of living in the United States has improved greatly. The same amount of work buys an increased quantity of goods, and items that were once luxuries, such as refrigerators and automobiles, are now widely available. As well, leisure time and life expectancy have increased, and annual hours worked have decreased.

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Standard of living in different nations:

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Actual standard of living may be disguised:

As an example, countries with a very small, very rich upper class and a very large, very poor lower class may have a high mean level of income, even though the majority of people have a low “standard of living”. This mirrors the problem of poverty measurement, which also tends towards the relative. This illustrates how distribution of income can disguise the actual standard of living. Likewise Country A, a perfectly socialist country with very low average per capita income would receive a higher score for having lower income inequality than Country B with a higher income inequality, even if the bottom of Country B’s population distribution had a higher per capita income than Country A. Real examples of this include former East Germany compared to former West Germany or North Korea compared to South Korea. In each case, the socialist country has a low income discrepancy (and therefore would score high in that regard), but lower per capita incomes than a large majority of their neighbouring counterpart. This can be avoided by using the measure of income at various percentiles of the population rather than the highly relative and controversial income inequality.

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Measurement of standard of living:

Standard of living is generally measured by standards such as real (i.e. inflation adjusted) income per person and poverty rate. Other measures such as access and quality of health care, income growth inequality, and educational standards are also used. Examples are access to certain goods (such as number of refrigerators per 1000 people), or measures of health such as life expectancy. It is the ease by which people living in a time or place are able to satisfy their needs and/or wants.

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Ways to measure your standard of living include:

1. GDP per capita (discussed vide supra)

2. HDI (discussed vide supra)

3. Satisfaction with Life Index:

Developed by a psychologist at the University of Leicester, the Satisfaction with Life Index attempts to measure happiness directly, by asking people how happy they are with their health, wealth, and education, and assigning a weighting to these answers. This concept is related to the idea of Gross National Happiness that came from Bhutan in the 1970’s. The idea is that material and spiritual development should take place side by side, underpinned by sustainable development, cultural values, conservation, and good governance.

4. Happy Planet Index:

The Happy Planet Index was introduced by the New Economics Foundation in 2006. The premise is that what people really want is to live long and fulfilling lives, not just to be filthy rich. The kicker is that this has to be sustainable both worldwide and down through the generations. The HPI is calculated based on life satisfaction, life expectancy, and ecological footprint. It doesn’t measure how happy a country is, but how environmentally efficient it is to support well-being in that country. In other words, if people are happy but they’re guzzling more than their fair share of natural resources, the country will not have a high Happy Planet Index. But if people are happy and have a medium environmental impact, or are moderately happy and with a low impact, the country’s score will be high.

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A new measure of standard of living:

Many people complain that conventional measures of GDP fail to capture a country’s true standard of living. But their attempts to improve on these conventional metrics are ad hoc. In a new paper Charles Jones and Peter Klenow of Stanford University propose a new measure of standards of living based on a simple thought experiment: if you were reborn as a random member of another country, how much could you expect to consume, in goods and leisure, over the course of your life? America, for example, has a higher GDP per person than France. But Americans also tend to work longer hours and live shorter lives. They also belong to a less equal society. If you assume that people do not know what position in society they will occupy, and that they dislike being poor more than they like being rich, they should prefer more egalitarian societies, everything else equal. For these reasons, the authors calculate that France and America have about the same standard of living as seen in the figure below. Nonetheless, broadly speaking, the figure below also shows falling standard of living with lower GDP per capita.

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Comparing Standards of Living in the Global Economy:

People living in the developed countries of the world enjoy a higher standard  of living than people living in the developing or transition countries. It is not possible to measure with any precision standard of living for peoples living in different world regions, who have different histories and cultures, and different values and world views. Yet, by examining some basic indicators, as shown below, we can piece together a general profile of a country and make some general commentary on the overall standard of living for the 7 billion people inhabiting the planet today. The standard of living comparisons will be made according to income status: high income countries, middle-income countries, and low-income countries.

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Health indicators:

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Availability of essential goods:

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Availability of essential services:

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As noted in three tables above, high income countries have best health indicators and maximum availability of essential services and goods. In other words, their standard of living is higher than middle and low income countries. In other words, high income countries are developed nations and rest developing nations.

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Quality of Life versus Standard of Living:

Quality of life and standard of living are often used interchangeably. But in fact they are two different concepts that are not necessarily related. Standard of living is generally measured by levels of consumption and thus, by levels of income. Satisfaction of basic needs of food, clothing and shelter are all standard of living issues. Quality of life is related to feeling good about one’s life and one’s self. One can have a very high standard of living and a low quality of life. And one can have a low standard of living and a high quality of life. It is not strange that we tend to confuse quality of life and standard of living.

• Increase in income may bring material comfort, but it certainly does not make one happy in life. This means that a high standard of living is no guaranty of a high quality of life.

• Standard of living is measurable as it is composed of indicators that are tangible and quantifiable. On the other hand, there are factors such as happiness, freedom and liberty in quality of life that are subjective and hard to evaluate.

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An evaluation of standard of living commonly includes the following factors:

•income

•quality and availability of employment

•class disparity

•poverty rate

•quality and affordability of housing

•hours of work required to purchase necessities

•gross domestic product (GDP)

•inflation rate

•number of paid vacation days per year

•affordable access to quality health care

•quality and availability of education

•life expectancy

•incidence of disease

•cost of goods and services

•infrastructure

•national economic growth

•economic and political stability

•political and religious freedom

•environmental quality

•climate

•safety

When you think about standard of living, you can think about things that are easy to quantify. We can measure factors like life expectancy, inflation rate and the average number of paid vacation days workers receive each year, for example.

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Factors that may be used to measure quality of life include the following:

•freedom from slavery and torture

•equal protection of the law

•freedom from discrimination

•freedom of movement

•freedom of residence within one’s home country

•presumption of innocence unless proved guilty

•right to marry

•right to have a family

•right to be treated equally without regard to gender, race, language, religion, political beliefs, nationality, socioeconomic status and more

•right to privacy

•freedom of thought

•freedom of religion

•free choice of employment

•right to fair pay

•equal pay for equal work

•right to vote

•right to rest and leisure

•right to education

•right to human dignity

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The main difference between standard of living and quality of life is that the former is more objective, while the latter is more subjective. Standard of living factors such as gross domestic product, poverty rate and environmental quality, can all be measured and defined with numbers, while quality of life factors like equal protection of the law, freedom from discrimination and freedom of religion, are more difficult to measure and are particularly qualitative. Both indicators are flawed, but they can help us get a general picture of what life is like in a particular location at a particular time. While standard of living is more concerned with a predetermined, artificial status that has become accepted as a measure of good living, quality of life is focused on more intangible objects that do not necessarily depend on wealth.

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Other approaches to assessing Development and Developing Countries:

Legatum Prosperity Index:

Some organizations have devised other approaches to evaluating the progress of developed and developing countries. The London-based Legatum Institute describes its Prosperity Index as “the world’s only global assessment of prosperity based on both income and well-being.” The Legatum Prosperity Index scores and ranks countries’ prosperity based on eight “foundations for national development,” including: economy, entrepreneurship and opportunity, governance, education, health, safety and security, personal freedom and social capital. The most recent version of the Prosperity Index covers 110 countries, whereas the HDI evaluates development indicators for 187 countries.

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Social progress index:

There have been numerous efforts to go beyond GDP to improve the measurement of national performance. The Social Progress Index is distinct from other wellbeing indices in its measurement of social progress directly, independently of economic development, in a way that is both holistic and rigorous. Most wellbeing indices, such as the Human Development Index and the OECD Your Better Life Index, incorporate GDP or other economic measures directly. These are worthy efforts to measure wellbeing and have laid important groundwork in the field. However, because they conflate economic and social factors, they cannot explain or unpack the relationship between economic development and social progress. The Social Progress Index has also been designed as a broad measurement framework that goes beyond the basic needs of the poorest countries, so that it is relevant to countries at all levels of income. It is a framework that aims to capture not just present challenges and today’s priorities, but also the challenges that countries will face as their economic prosperity rises.

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Inadequacy of mainstream economics:

Our main tool for understanding poor countries – mainstream economics – is woefully inadequate and all about the rich world.  A sample of 76,000 economics journal articles published between 1985 and 2005 shows that more papers were published about the United States than on Europe, Asia, Latin America, the Middle East and Africa combined. Economists start from the assumption that humans are individualistic, utility-maximising and strictly rational in a narrow sense. Actually many people are communitarian, social, non-calculating, uncertain about the future and often act according to sentiment or whim. Mainstream economics allows no theory of power or politics and can’t see the world economy as a system.  The economic statistics on poor countries are awful. The most basic metric of development, GDP, should not be treated as an objective number but rather as a number that is a product of a process in which a range of arbitrary and controversial assumptions are made. The discrepancy between different GDP estimates is up to a half in some cases. In the least developed countries, statistics offices are usually underfunded and don’t have the resources to collect data often or well enough.

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Classification of nations based on their development:

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Four Worlds:

After World War II the world split into two large geopolitical blocs and spheres of influence with contrary views on government and the politically correct society:

1 – The bloc of democratic-industrial countries within the American influence sphere, the “First World”.

2 – The Eastern bloc of the communist-socialist states, the “Second World”.

3 – The remaining three-quarters of the world’s population, states not aligned with either bloc were regarded as the “Third World.”

4 – The term “Fourth World” refers to widely unknown nations (cultural entities) of indigenous peoples, living within or across national state boundaries.

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Although classification into first, second and third word was political, it is almost economical with first world high income, second world middle income and third world low income countries.

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What makes a nation third world?

Despite ever evolving definitions, the concept of the third world serves to identify countries that suffer from high infant mortality, low economic development, high levels of poverty, low utilization of natural resources, and heavy dependence on industrialized nations. These are the developing and technologically less advanced nations of Asia, Africa, Oceania, and Latin America. Third world nations tend to have economies dependent on the developed countries and are generally characterized as poor with unstable governments and having high rates of population growth, illiteracy, and disease. A key factor is the lack of a middle class — with impoverished millions in a vast lower economic class and a very small elite upper class controlling the country’s wealth and resources. Most third world nations also have a very large foreign debt. These countries were at one point colonies which were formally led by imperialism. The end of imperialism forced these colonies to survive on their own. With lack of support, these colonies started to develop characteristics such as poverty, high birth rates and economic dependence on other countries. The term was then affiliated to the economic situation of these former colonies and not their social alliances to either capitalism or communism.

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Global North and Global South:

The terms “Global North” and “Global South” divide the world in half both geographically. The Global North contains all countries north of the Equator in the Northern Hemisphere and the Global South holds all of the countries south of the Equator in the Southern Hemisphere. This classification groups the Global North into the rich northern countries, and the Global South into the poor southern countries. This differentiation is based on the fact that most of developed countries are in the north and most of the developing or underdeveloped countries are in the south. Issue with this classification is that not all countries in the Global North can be called “developed,” while some of the countries in the Global South can be called developed. In the Global North, some examples of the developing countries include: Haiti, Nepal, Afghanistan, and many of the countries in northern Africa. In the Global South, some examples of the well-developed countries include: Australia, South Africa, and Chile.

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The map above shows North South divide. MEDCs are countries which have a high standard of living and a large GDP. LEDCs are countries with a low standard of living and a much lower GDP. Most of the southern hemisphere is less developed, while countries in the northern hemisphere are more developed.

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North-South divide:

The North–South divide is broadly considered a socio-economic and political divide. Generally, definitions of the Global North include North America, Western Europe and developed parts of East Asia. The Global South is made up of Africa, Latin America, and developing Asia including the Middle East. The North is home to four of the five permanent members of the United Nations Security Council. The North mostly covers the West and the First World, along with much of the Second World, while the South largely corresponds with the Third World. While the North may be defined as the richer, more developed region and the South as the poorer, less developed region, many more factors differentiate between the two global areas. 95% of the North has enough food and shelter. Similarly, 95% of the North has a functioning education system. In the South, on the other hand, only 5% of the population has enough food and shelter. It “lacks appropriate technology, it has no political stability, the economies are disarticulated, and their foreign exchange earnings depend on primary product exports”. In economic terms, the North—with one quarter of the world population—controls four fifths of the income earned anywhere in the world. 90% of the manufacturing industries are owned by and located in the North. Inversely, the South—with three quarters of the world populations—has access to one fifth of the world income. It serves as a source for raw material as the North which subjected large portions of the global South to direct colonial rule.

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Classification of countries based on economic development:

Countries are categorized according to their economic development. The United Nations classifies countries as developed, developing, newly industrialized or developed, and countries in transition such as Kazakhstan, Kyrgyztan, Turkmenistan, and the former USSR. The classification of countries as a developed and developing country is based on economic status like GDP, GNP, per capita income, industrialization, standard of living, etc.

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The classification of a country does not only depend on its income but also on other factors that affect how their citizens live, how their economies are integrated into the global system, and the expansion and diversification of their export industries.   A developed country is one that has a high level of industrial development, bases its economy on technology and manufacturing instead of agriculture. The factors of production such as human and natural resources are fully utilized resulting in an increase in production and consumption which leads to a high level of per capita income. A country with a high Human Development Index (HDI) rating is considered a developed country. It not only measures the economic development and GDP of a country but also its education and life expectancy. A developed country’s citizens enjoy a free and healthy existence. The term “developed country” is synonymous to “industrialized country, post-industrial country, more developed country, advanced country, and first-world country.” The United Kingdom, France, Germany, Canada, Japan, Switzerland, and the United States of America are only a few of those considered as developed countries.  A developing country, on the other hand, is one that has a low level of industrialization. It has a higher level of birth and death rates than developed countries. Its infant mortality rate is also high due to poor nutrition, shortage of medical services, and little knowledge on health. The citizens of developing countries have a low to medium standard of living because their per capita income is still developing, and their technological capacity is still being developed. There is also an unequal distribution of income in developing countries, and their factors of production are not fully utilized. Developing countries are also referred to as third-world countries or least-developed countries.

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A more popular, though apparently more disputable, approach involves dividing all countries into “developing” and “developed”—despite the general understanding that even the most developed countries are still undergoing development. Dividing countries into “less developed” and “more developed” does not help much, because it is unclear where to draw the line between the two groups. In the absence of a single criterion of a country’s development, such divisions can only be based on convention among researchers. For example, it is conventional in the World Bank to refer to low-income and middle-income countries as “developing,” and to refer to high-income countries as “industrial” or “developed.” The relatively accurate classification of countries into “developing” and “developed” based on their per capita income does not, however, work well in all cases. There is, for instance, a group of “high-income developing countries” that includes Israel, Kuwait, Singapore, and the United Arab Emirates. These countries are considered developing because of their economic structure or because of the official opinion of their governments, although their incomes formally place them among developed countries. Another challenge is presented by many of the countries with “transition” or “formerly planned” economies—that is, countries undergoing a transition from centrally planned to market economies. On the one hand, none of these countries has achieved the established threshold of high per capita income. But on the other, many of them are highly industrialized.

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MDCs and LDCs:

“MDC” stands for More Developed Country and “LDC” stands for Least Developed Country. The terms MDCs and LDCs are most commonly used by geographers. This classification is a broad generalization but it can be useful in grouping countries based on factors including their GDP per capita, political and economic stability, and human health, as measured by the Human Development Index (HDI). While there is debate as to at what GDP threshold an LDC becomes and MDC, in general, a country is considered an MDC when it has a GDP per capita of more than US $4000, along with a high HDI ranking and economic stability.

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LEDC and MEDC countries:

LEDC stands for Less Economically Developed Country and MEDC stand for More Economically Developed Country. LEDC’s and MEDC’s are determined due to many things such as the standard of living in that country, the birth rate, the death rate, the infant mortality etc. MEDC countries have better standard of living i.e. a higher birth rate, a higher death rate, a higher infant mortality etc. As LEDC countries are less developed, they have lower rates and standard of living. The main difference between LEDC’s and MEDC’s is the level of industrial development. Kenya, Afghanistan, and India are examples of LEDC’s. The United States, Japan, and the UK are examples of MEDC’s.

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Developed and Developing Countries:

The most commonly used terms to describe and differentiate between countries are “developed” and “developing” countries. Developed countries describes the countries with the highest level of development based on similar factors to those used to distinguish between MDCs and LDCs, as well as based on levels of industrialization. These terms are the most frequently used and the most politically correct; however, there is really no actual standard by which we name and group these countries. The implication of the terms “developed” and “developing” is that developing countries will attain developed status as some point in the future.

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Origin of the Term:

After World War II, the world saw the birth of many new nations. It also saw the establishment of the United Nations, an institution focused on cooperation among countries. The richest countries began to see it as their responsibility to support new and less industrialized nations. More international organizations were established with the mission of helping richer nations send money and resources to poorer nations to help them grow and modernize.  By the 1960s, many scholars and economists began to use the term developing nation to describe these nations that had a mostly agriculturally based economy, high population growth, and high unemployment. The focus on these developing countries picked up more momentum in the year 2000, when the UN General Assembly adopted the Millennium Declaration. This included a commitment to specific development goals, like cutting in half the proportion of the world’s people living on less than $1 a day by 2015.

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Confusing Classification:

It’s not always clear where to draw the line between developed and developing nations, like in the case of Russia and China. These countries have extremely productive industrial bases, but are still classified as developing nations because of other factors. These factors can range from economic status to quality of life. International organizations use different information and standards to make their classifications.

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Money Matters:

The IMF (International Monetary Fund) and World Bank look primarily at economic statistics for classifying nations. They look at how strong a nation’s economy is, how much money the average citizen has, and what sort of industry and resources a nation has. For example, in 2002 the World Bank looked at the GNI (Gross National Income) per capita of nations to analyze development. But even those statistics can vary. For example, the GNI per capita of Ethiopia was $100, while in Malaysia it was $3380, but they are both considered developing nations.

 

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Although economic statistics are very important, they don’t tell a complete story. In the 1990′s, Amartya Sen, winner of the 1998 Nobel Prize in economics, began arguing that we can’t just look at a nation’s economy to determine if it’s developing. He suggested that development must look at an average citizen’s standard of living.

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OECD:

The developing/developed countries taxonomy became common in the 1960s as a way to easily categorize countries in the context of policy discussions on transferring resources from richer to poorer countries. For want of a country classification system, some international organizations have used membership of the Organization of Economic Cooperation and Development (OECD) as a main criterion for developed country status. Though not expressly stating a country classification system, the preamble to the OECD convention does include a reference to the belief of the contracting parties that economically more advanced nations should co-operate in assisting to the best of their ability the countries in process of economic development. This consequently resulted in about 80-85 percent of the world’s countries labelled as developing and 15-20 percent as developed.

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Due to the absence of a methodology in classifying countries based on the level of development, I will focus on the development taxonomies of the UNDP, World Bank and IMF.

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A. United Nations Development Programme’s (UNDP) Country Classification System:

The UNDP’s country classification system is calculated from the Human Development Index (HDI), which aims to take into account the multifaceted nature of development. HDI is a composite index of three indices measuring countries achievement in longevity, education and income. To identify high HDI achievers and consequently developed countries, the UNDP used a number of factors. One way is to look at countries with positive income growth and good performance on measures of health and education relative to other countries at comparable levels of development. Another way was to look for countries that have been more successful in closing the “human development gap,” as measured by the reduction in their HDI shortfall (the distance from the maximum HDI score).

 

B. World Bank’s Country Classification Systems:

The classification tables include all World Bank members, plus all other economies with populations of more than 30,000. The World Bank’s classification of the world’s economies is based on estimates of gross national income (GNI) per capita PPP. The GNI is gross national income converted to international dollars using purchasing power parity rates. An international dollar has the same purchasing power over GNI as a U.S. dollar has in the United States. The GNI per capita is also used as input to the Bank’s operational classification of economies, which determines their lending eligibility. As of 1 July 2015, low-income economies are defined as those with a GNI per capita, calculated using the World Bank Atlas method, of $1,045 or less in 2014; middle-income economies are those with a GNI per capita of more than $1,045 but less than $12,736; high-income economies are those with a GNI per capita of $12,736 or more. Lower-middle-income and upper-middle-income economies are separated at a GNI per capita of $4,125. The term country, used interchangeably with economy, does not imply political independence but refers to any territory for which authorities report separate social or economic statistics.  Low- and lower middle-income economies are usually referred to as developing economies, and the Upper Middle Income and the High Income are referred to as Developed Countries. The World Bank adds that the term is used for convenience; ‘it is not intended to imply that all economies in the developing group are experiencing similar development or that other economies in the developed group have reached a preferred or final stage of development’.

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Why use GNI per capita to classify economies into income groupings?

While it is understood that GNI per capita does not completely summarize a country’s level of development or measure welfare, it has proved to be a useful and easily available indicator that is closely correlated with other, nonmonetary measures of the quality of life, such as life expectancy at birth, mortality rates of children, and enrolment rates in school. There are some limitations associated with the use of GNI that users should be aware of. For instance, GNI may be underestimated in lower-income economies that have more informal, subsistence activities. Nor does GNI reflect inequalities in income distribution.

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C. IMF’s Country Classification Systems:

The IMF uses a flexible classification system that considers (1) per capita income level, (2) export diversification—so oil exporters that have high per capita GDP would not make the advanced classification because around 70% of its exports are oil, and (3) degree of integration into the global financial system. The IMF uses either sums or weighted averages of data for individual countries. However, the IMF’s statistical Appendix explains that this is not a strict criterion, and other factors are considered in deciding the classification of countries. The IMF refers to the classification of countries as Advanced and Emerging and Developing Economies. Advanced Economies are sub-catergorised into Euro Area, Major Advanced Economies (G7), Newly Industrialized Asian Economies, Other Advanced Economies (Advanced Economies excluding G7 and Euro Area), and the European Union. The Emerging and Developing Economies are sub categorised into Central and Eastern Europe, Commonwealth of Independent States, Developing Asia, ASEAN-5, Latin America and the Caribbean, Middle East and North Africa, Sub-Saharan Africa.

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Country Classification Systems in Selected International Organizations:

UNDP IMF World Bank
Name of Developed Country Developed Countries Advanced Countries High income countries
Name of Developing Country Developing Countries Emerging and developing countries Low- and middle-income countries
Development Threshold 75 percentile in the HDI distribution Not explicit US$ 4000 GNI per capita
Subcategories of developing countries (1) Low human development countries, (2)Medium human development countries, and (3) High human development countries 1) Low-income developing countries and(2) Emerging and other developing countries (1) Low-income countries and(2) Middle-income countries

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The CIA gives the following definitions:

•Advanced Economies: A term used by the International Monetary Fund (IMF) for the top group in its hierarchy. Similar to the term “Developed countries” but adds Hong Kong, South Korea, Singapore and Taiwan, but drops Malta, Mexico, South Africa, and Turkey.

•In transition: A term used by the International Monetary Fund (IMF) for the middle group in its hierarchy. This group is identical to the group traditionally referred to as the “former USSR/Eastern Europe”. The group includes the countries which are close to reaching “advanced economy” status, such as Moldova, Albania, Montenegro, FYR Macedonia, Serbia, Bosnia and Herzegovina, Armenia, Georgia, Azerbaijan, Turkmenistan, Uzbekistan, Kazakhstan, Kyrgyzstan, Tajikistan, Belarus and Ukraine.

•Less developed: The bottom group in the hierarchy. Mainly countries and dependent areas with low levels of output, living standards, and technology; per capita GDPs are generally below $5,000 and often less than $1,500; however, the group also includes a number of countries with high per capita incomes, areas of advanced technology, and rapid rates of growth; includes the advanced developing countries, developing countries, low-income countries, middle-income countries, newly industrialized economies (NIEs), the South, Third World, and underdeveloped countries.

•Least developed: Subgroup of the less developed countries (LDCs) initially identified by the UN General Assembly in 1971 as having no significant economic growth, per capita GDPs normally less than $1,000, and low literacy rates; also known as the undeveloped countries.

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After going through so many different classifications of nations by different agencies, I put forward simplified version of classification:

HDI GNI PPP per capita in US$ Development status
>0.85 >12000 Developed nations
0.75 to 0.85 4000 to 12000 Nations in transition
0.5 to 0.75 1000 to 4000 Developing nations
<0.5 < 1000 Least developed nations

In event of inconsistency between HDI and GNI per capita for developmental status, please go by HDI because HDI includes GNI per capita besides health and education. In other words, if GNI per capita puts nation in higher development status compared to HDI, it means more industrial development without concomitant improvement in health and education. The classical example is India whose GNI per capita PPP is 5497 US$ making it transition nation but HDI 0.609 making is developing nation.  The implication of the terms “developed” and “developing” is that developing countries will attain developed status as some point in the future.

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Overlap between developed and developing nations:

 

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Characteristics of a developed nation:

Developed Countries are the countries which are developed in terms of economy and industrialization. The Developed countries are also known as Advanced countries or the first world countries, as they are self-sufficient nations. Human Development Index (HDI) statistics rank the countries on the basis of their development. The country which is having a high standard of living, high GDP, high child welfare, health care, good medical, transportation, communication and educational facilities, better housing and living conditions, industrial, infrastructural and technological advancement, higher per capita income, increase in life expectancy etc. are known as Developed Country. These countries generate more revenue from the service sector as compared to industrial sector as they are having a post-industrial economy. They are contrasted with developing countries, which are in the process of industrialization, or undeveloped countries, which are pre-industrial and almost entirely agrarian. The following are the names of some developed countries: Australia, Canada, France, Germany, Italy, Japan, Norway, Sweden, Switzerland, and United States. To be considered a developed nation, a country generally has a per capita income around or above $12,000. In addition to having high per capita income and stable population growth rates, developed nations are also characterized by their use of resources. In developed countries, people consume large amounts of natural resources per person and are estimated to consume almost 88% of the world’s resources. According to the International Monetary Fund, advanced economies comprise 60.8% of global nominal GDP and 42.9% of global GDP (PPP) in 2014. Some of the common characteristics of a developed economy are low birth rate and higher life expectancy, high level of literacy and a well trained workforce and the export of high value added goods.

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Similar terms:

Terms similar to developed country include “advanced country”, “industrialized country”, “‘more developed country” (MDC), “more economically developed country” (MEDC), “Global North country”, “first world country”, and “post-industrial country”. The term industrialized country may be somewhat ambiguous, as industrialization is an on-going process that is hard to define. The first industrialized country was the United Kingdom, followed by Belgium. Later it spread further to Germany, United States, France and other Western European countries. According to some economists such as Jeffrey Sachs, however, the current divide between the developed and developing world is largely a phenomenon of the 20th century.

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Generalized characteristics of developed countries:

•Post-industrial economies

•High level of industrial development

•High level of affluent citizens

•Low levels of unemployment

•Higher education rates

•Technological advantages

•Better roads

•Stable governments

•Good health care

•Human and natural resources are fully utilized

•High level of per capita income

•High Human Development Index (HDI)

•Increased life expectancy

•Low birth rates

•Low death rates

•Good housing conditions

•Safe water supplies

•Abundant food supplies

•Easy to access advanced medical services

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Characteristic of developing nations:

The countries who are going through the initial levels of industrial development along with low per capita income are known as Developing Countries. These countries come under the category of third world countries. They are also known as lower developed countries. Developing Countries depend upon the Developed Countries, to support them in establishing industries across the country. The country has a low Human Development Index (HDI) i.e. the country does not enjoy healthy and safe environment to live, low Gross Domestic Product, high illiteracy rate, poor educational, transportation, communication and medical facilities, unsustainable government debt, unequal distribution of income, high death rate and birth rate, malnutrition both to mother and infant which case high infant mortality rate, poor living conditions, high level of unemployment and poverty. The following are the names of some developing countries: China, Colombia, India, Kenya, Malaysia, Singapore, Sri Lanka, Thailand, Turkey, U.A.E. Terms such as “emerging countries,” “third world countries” and “developing countries,” are commonly used to refer to countries that do not enjoy the same level of economic security, industrialization and growth as developed countries. The United Nations Conference on Trade and Development (UNCTAD) points out that the least developed of the developing countries are “deemed highly disadvantaged in their development process – many of them for geographical reasons – and (face) more than other countries the risk of failing to come out of poverty.”

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Similar terms:

A variety of terms have been used to refer to these “developing” countries. These include less-developed countries, underdeveloped countries, undeveloped countries, backward countries, Third World countries, and newly industrializing countries. Except for Third World, which was advanced in the late 1960s and early 1970s to refer affirmatively to countries that were politically independent of the United States and the Soviet Union, these terms are more-or-less pejorative. Newly industrializing is more specific than the other terms, in that it refers to a limited number of countries that have begun industrializing since the 1970s.

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Developing nations can be divided further into moderately developed or less developed countries. Moderately developed countries have an approximate per capita income of between $1,000 and $12,000. The average per capita income for moderately developed countries is around $4,000. As of 2012, the list of moderately developed nations is very long and accounts for around 4.9 billion people. Some of the most recognizable countries that are considered moderately developed include Mexico, China, Indonesia, Jordan, India, Thailand, Fiji, and Ecuador. In addition to these specific countries, many others from Central America, South America, northern and southern Africa, south-eastern Asia, Eastern Europe, the former U.S.S.R., and many Arab states, are all considered moderately developed countries. Less developed countries are the second type of developing nations. They are characterized by having the lowest income, with a general per capita income of approximately less than $1,000. In many of these countries the average per capita income is even lower, at around $500. The countries listed as less developed are found in eastern, western, and central Africa, and other countries in southern Asia. In 2012, there were around 0.8 billion people who lived in these countries and survived on very little income.  Overall, in 2012, developing nations accounted for a total of 5.7 billion people. Even though the income range is quite large, there are still nearly 3 billion people that live on less than $2 a day. Can you image living on less than $2 a day? That would be a very hard task for most of us to do. In addition to low income levels, developing countries are also characterized as having high population growth rates. It is estimated that these countries are going to increase by 44% over the next 40 years. By 2050, it is predicted that over 86% of the human population will live in developing countries.

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For the purposes of World Bank financing, debt relief, technical assistance and advisory services, and special initiative, developing countries are categorized as Heavily Indebted Poor Countries (HIPC), Middle-Income Countries (MIC), Low-Income Countries Under Stress (LICUS) and Small States. Middle-income countries, have made great strides in successfully entering the world economy and are creating better-paying jobs, better and more equitably available education and health services, and are investing in infrastructure improvements. However, middle-income countries continue to face substantial development challenges: achieving sustained growth that provides productive employment; reducing poverty and inequality; reducing volatility, particularly in their access to private financial markets; and strengthening the institutional and governance structures that underpin viable market-based economies.

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A developing country may be one:

◦That is largely rural or with a population that is migrating to poorly equipped cities, with a low-performing economy that is based primarily on agriculture and where non-agricultural jobs are scarce and low-paying;

◦Where the populace is often hungry and sorely lacks education, where there is a large knowledge gap and technological innovation is scarce;

◦Where health and education systems are poor and/or lacking and where transportation, potable water, power and communications infrastructure is also scarce;

◦Where the amount of government debt is unsustainable;

◦Where the land mass, population, and domestic markets are small and far disbursed, often on remote islands or in island groups, susceptible to natural disasters, with limited institutional capacity, limited economic diversification; and/or

◦Where government has collapsed and armed conflict has left a fragile state with weak institutions and policies, either unwilling or unable to provide basic social services, especially for the poor. It is estimated that a third of people living in absolute poverty around the world live in fragile states in a vicious cycle of poverty and conflict.

Implicit in the term developing countries is the suggestion that things will improve over (some unforeseeable period of) time. However, this terminology has been used to hide the exploitation and oppression of people in the so-called developing countries—exploitation by corporations headquartered in the developed countries, by dictators installed or supported by the U.S. government or its allies, or by the governments and militaries of the developing countries themselves.

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Economies in transition:

Since the fall of the Berlin Wall, a new category, Economies in Transition, has come about. These include most of the former Soviet Union countries and often include South Africa. Conditions are not as bad as in developing countries but neither are they developed. The potential in these markets is great, as are the risks.

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Newly industrialized country:

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Newly industrialized country (NIC), country whose national economy has transitioned from being primarily based in agriculture to being primarily based in goods-producing industries, such as manufacturing, construction, and mining, during the late 20th and early 21st centuries. An NIC also trades more with other countries and has a higher standard of living than developing countries. However, it has not yet reached the level of economic advancement of developed countries and regions such as the United States, Japan, and Western Europe. NICs began to be recognized during the second half of the 20th century, when economies such as those of Hong Kong, South Korea, Singapore, and Taiwan underwent rapid industrial growth. Several other countries—such as Turkey, Thailand, Malaysia, Mexico, Brazil, Argentina, South Africa, Russia, China, and India—industrialized during the late 20th and early 21st centuries. Each experienced a general rise in per capita income, although a higher income does not necessarily reflect a higher development status. For example, India and China, because of their large populations, have low per capita incomes even though they have significant economic growth rates and large manufacturing sectors. Industrialization and growth in NICs has been achieved through diverse means: for example, import substitution (substituting domestically produced products for those previously imported) in India, export-oriented growth in Taiwan and South Korea, investment in fossil-fuel extraction in Russia, and attraction of inward foreign investment in China. Yet there are some common features usually shared by NICs. Those include political and economic reforms allowing for greater civil rights and market liberalization, strengthening of the legal and economic environment to foster increased competition and privatization of industries, and trade liberalization policies allowing increased exchange of goods and cross-border investment. In almost all NICs, greater industrialization has led to increased trade, greater economic growth, participation in regional trading blocs, and attraction of foreign investment, especially from developed countries.

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Landlocked developing countries:

Landlocked developing countries (LLDC) are developing countries that are landlocked. Landlocked developing countries are countries with serious constraints on the overall socio-economic development due to lack of territorial access to the sea and therefore remoteness and isolation from world markets causing high transit and transportation costs. These countries are among the poorest of the developing countries, of the thirty landlocked developing countries in the world, sixteen are classified as being least developed. High transport costs due to distance and terrain result in the erosion of competitive edge for exports from landlocked countries. Also, the constraints on landlocked countries to be mainly physical, as in lack of direct access to the sea, isolation from world markets and high transit costs due to physical distance. Geographic remoteness is one of the most significant reasons as why developing landlocked nations are unable to alleviate themselves while European landlocked cases are mostly developed because of short distances to the sea through well-developed transient countries.

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Least developed country:

A least developed country (LDC) is a country that, according to the United Nations, exhibits the lowest indicators of socioeconomic development, with the lowest Human Development Index ratings of all countries in the world. A country is classified as a Least Developed Country if it meets three criteria:

•Poverty, GNI PPP per capita less than 1000 US$

•Human resource weakness (based on indicators of nutrition, health, education and adult literacy)

•Economic vulnerability (based on instability of agricultural production, instability of exports of goods and services, economic importance of non-traditional activities, merchandise export concentration, handicap of economic smallness, and the percentage of population displaced by natural disasters)

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Characteristics of Developing countries:

Developing or underdeveloped countries are those countries in which most of the citizens are compelled to live below poverty line. As a result of this problems in consumption arise in various time periods due to scarcity or shortages of goods and services. In such countries technical and monetary level will be of low quality. In such countries there will be no proper association between production, consumption and distribution. As a result of unemployment propensity to consume will be high resulting in low saving and low investment. In such countries available natural resources will not be utilized property or adequately. In view of these various reasons the per capita income of such countries will also be low. Developing or underdeveloped economy is that economy in which there are low level of living, absolute poverty, low per capita income, low consumption level, poor health services, high death and birth rates and dependence on foreign countries. Despite having high possibilities of economic development such countries are in the group of underdeveloped countries. Low per capita income, unequal distribution of national income, major section of the people dependent upon agriculture, inefficient administration, objectiveless political parties, lack of development in industries, lack of job oriented education, etc. are the characteristics of underdeveloped countries. Developing countries have a burgeoning youthful population and a great need for necessities at low prices. They often provide lucrative markets for services and products associated with infrastructure upgrading, particularly where development aid is available to fund certain projects.

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Among other maladies, developing countries suffer from poor sanitation, nutrition, and education.

Sanitation:

In 2004, 2.6 billion people, or more than 40% of the world’s population, did not have access to basic sanitation. In Kevin Watkins’ (head of the United Nations Development Program) words, “‘No access to sanitation’ is a polite way of saying that people draw water for drinking, cooking and washing from rivers, lakes, ditches and drains fouled with human and animal excrement. Over one billion people drink unsafe water, and the poor sanitation contributing 1.8 million deaths of children each year from diarrhoea, the second largest cause of global children mortality.  According to the 2006 Human Development Report, of which Watkins was the principal author, a child has a 60% better chance of reaching one year of age if a toilet is installed at home. As UNICEF’s Executive Director Carol Bellamy states, “children are being born into a silent emergency of simple needs” and the disparity between the developed and developing world must be addressed.

Hunger:

Food represents yet another basic necessity. It is neither unreasonable nor is it novel, but nearly 16,000 children die from hunger-related causes each day. These deaths account for one third of child deaths around the world. The world is in a tragic situation where the developing world suffers from under-nourishment while the developed world lounges in over-nourishment.

Education:

As with sanitation and nutrition, developing countries lack in the education sector. One in five children does not attend school. For those that can attend 4 – 6 years of school, 30 – 50% cannot read or write. In September 2001, there were 1 billion non-literate adults, which is equivalent to 26% of the world adult population. 98% of nonliterates live in developing countries, and 2/3 of non-literates are women. Although education is a serious issue, people often raise the question whether education is even worth improving, when compared with the struggle to survive. Such a viewpoint proposes that the world should only concentrate on one specific aspect, but the plight of developing countries is a complex one, and so it should be addressed from different angles and in every way possible.

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Some of the characteristics of developing countries are:

•A low average real per capita income

•A high proportion of the labour force being involved in agriculture and other primary activities

•Low life expectancy

•A high rate of illiteracy

•A high rate of population growth

• Tend to have serious shortages of foreign exchange

•To be more protectionist about their economies and industries than industrialised countries. (I.e. Trade is restricted in order to protect local producers against competition from foreign producers of the same product(s), as well as to stimulate employment).

•High infant mortality

•Less medical facilities

•Poor sanitation

•Low standard of living

•Inadequate housing

•Low levels of labour productivity

•High level of unemployment and under employment

•Technological backwardness

•Less agriculture productivity

•Often contain undeveloped rural villages

•Unstable governments

•High level of birth rates

•High level of death rates

•Dirty, unreliable water supplies

•Poor nutrition

•Limited technological capacity

•Unequal distribution of income

•Factors of production are not fully utilized

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The most important structural features of developing countries:

1. Lower per-capita income

2. Low levels of human capital

3. High levels of poverty and under-nutrition

4. Higher population growth rates

5. Predominance of agriculture and low levels of industrialization

6. Low level of urbanization but rapid rural-to-urban migration

7.  Dominance of informal sector

8. Underdeveloped labor, financial, and other markets.

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1. Lower Per-Capita Income:

As we have already discussed, developing countries have lower per-capita income compared to developed countries. Figure above depicts the annual per-capita income of selected countries in 2005 in the U.S. dollar. Figure shows a wide disparity in income levels. In 2005, the country with the highest per capita income, Switzerland, had 345 times the per capita income of one of the poorest countries of the world, Ethiopia, and 76 time that of one of the world’s largest nations, India. However, such per-capita income comparison exaggerates the differentials in standards of living between developing and developed countries. That is because per-capita income in terms of PPP in developing countries is much higher compared to per-capita income in terms of nominal exchange rate. For example, the exchange rate per-capita income in Bangladesh was $470, but PPP per-capita income was $2,090 in 2005. Measured in PPP dollars, the gap between the United Sates and Burundi would be 66 to 1 rather than 436 to 1 as measured at the official exchange rate.

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2. Low Levels of Human Capital:

Table above summarizes various indicators of health and education. It shows that low income countries have substantially lower life expectancy at birth and higher under-5 mortality rate compared to high income countries. The average life expectancy in low income countries in 2005 was 59 years, while in high income countries it was 79 years. Thus, people in high income countries, on average, live 20 more years than people in low income countries.

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Education:

Table above shows net primary school enrolment rate and student (pupil)-teacher ratio in primary schools for 2005. Net primary school enrolment rate is defined as the ratio of the number of children actually attending primary school to the number of school-age children in the population. Student-teacher ratio captures the quality of education. Higher is this ratio, lower is the quality of schooling. Table clearly shows that low income countries have lower primary school enrolment and much higher student-teacher ratio. Only 78 percent of children (5-14) in low income countries go to school. Also the children who go school, they receive lower quality of education. Regional pattern shows that Sub-Saharan countries have the lowest primary school enrolment and the highest student-teacher ratio followed by South Asian countries.

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3. High Levels of Poverty and Under-Nutrition:

Developing countries, particularly low income countries, are characterized by very high incidence of poverty and prevalence of hunger and under-nutrition. Figure above depicts the trend in number of people living in abject poverty in various regions of world in 2002. The incidence of abject poverty varies widely around the developing world. The world Bank estimates that the share of the population living on less than $ 1 a day is 9.1% in East Asia and the Pacific, 8.6% in Latin America and Caribbean, 1.5% in the Middle East and North Africa, 31.7% in South Asia, and 41.1% in Sub-Saharan Africa. The incidence of people living in extreme poverty has declined over years. However, most of the decline has taken place in East Asian and Pacific Region. The decline in Sub-Saharan and South Asian regions has been painfully slow.

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4. Higher Population Growth Rate:

Developing countries, particularly low income countries, are characterized by relatively high population growth rate despite the fact that they have high child mortality rate. High population growth rate is due to very high birth rate.

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5. Predominance of Agriculture and Low Levels of Industrialization:

One striking feature of developing countries is that agriculture accounts for a large part of gross domestic product and employment. In many developing countries, agriculture accounts for more than a quarter of GDP. Its dominance in employment is even more striking. In many developing countries, majority of male and female are employed in agriculture.

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6. Low Level of Urbanization:

Most of the people in developed countries live in urban areas. On the other hand, the share of urban population in developing countries is much smaller. Only 41 percent of population lived in urban areas in less developed countries, while the share of urban population was 77 percent in more developed countries. The share of urban population is particularly low in South Central Asia and Sub-Saharan countries. Figure above traces relationship between the level of urbanization and per-capita income. It shows a strong positive relationship between the two. Higher the per-capita, larger is the level of urbanization. In any developing world country there are massive differences between urban and rural areas. Rural areas are far less likely to have access to clean water and sanitation, health and education facilities or to get help from international aid.

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7. Dominance of Informal Sector:

One very important feature of the developing countries is the dominance of informal sector in economic activities. The main characteristics of the informal sector jobs are: (i) low skill, (ii) low productivity, (iii) self-employment (iv) lack of complementary inputs particularly capital, (v) small scale measured in terms of sales, assets, employment etc., (vi) favored by recent migrants, (vii) ease of entry for employers and workers, and (viii) lack of formal contractual agreements. Rural areas in developing countries are largely informal. Even in cities informal sector in developing countries is quite big. Due to the dominance of informal sector, most of the workers are engaged in low productivity and low paying jobs. Dominance of the informal sector is largely due to underdeveloped labor, financial, and other markets in developing countries.

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8. Underdeveloped Labor, Financial, and Other Markets:

Markets and institutions in developing countries are quite different from markets and institutions in developed countries. Markets and institutions are largely informal in developing countries. Informality of these markets can largely be traced to informational and incentive constraints and limits to contractual enforcement.

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Diversity between developing countries:

Despite common characteristics and structural similarity, no two less economically developed countries are the same! There is a huge amount of diversity between them. Think about some of the key structural economic differences between nations – for example:

1. The size of an economy (i.e. population size, basic geography, annual level of national income)

2. Historical background including years since independence from colonial rule

3. Natural resource endowment

4. The age structure of the population

5. Ethnic and religious composition

6. Relative size / importance of public and private sectors of the economy

7. Structural of national output (e.g. primary, secondary, tertiary and quarternary sectors)

8. Structure of international trade (both geographical and the commodity pattern of trade)

9. Political stability, strength of democratic institutions, transparency of government

10. Ethnic and gender equality and tolerance

11. The ease with which new businesses can be created and sustained

12. Other competitiveness indicators including the relative size and strength of high-knowledge / high-technology industries

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Why are poor countries poor?

There is probably no simple answer to that question. Most likely, there are numerous factors that play a role as discussed below. A number of countries in this world are economically less developed. There is no clear definition of what a “poor country” is. The common understanding is that a country is poor if the majority of its people do not have a certain minimum living standard.  There is considerable dispute about the right term for “poor countries”. The word “poor” has a very negative connotation. Furthermore, “poor countries” are not necessarily poor: They often have vast natural resources. On the other hand, terms such as “developing” or “industrializing” are very positive. These terms imply that the country would actually be moving out of poverty although presently life is hard for a large number of people.

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Factors contributing to a country’s level of development:

A country’s level of development is influenced by a number of interrelated factors. Clearly geography plays a role.  Climate, raw materials, farmland, fresh water, access to the sea, and other factors all help a nation grow and prosper. History, too, has an influence. In nations with established traditions of political independence, democracy, social mobility, and a relatively free market, people are generally more efficient and less corrupt and thus better able to use foreign aid for its intended purpose. While it is difficult to separate these factors, they can be broken down into several major categories: geographical, historical, political, economic, human, social, cultural and environmental. Most developing nations of the world face development challenges as a result of a combination of these factors. These factors are responsible for making a nation developed or developing. Some environmental factors which contribute to a country’s level of development, such as natural disasters, are beyond human control. The majority of the development issues however have been created and continue due to the direct actions of humans. The very high rate and level of development experienced by most rich countries of the world is another factor which perpetuates many challenges faced by people in developing countries.

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A. Historical factors that affect development:

Studying the past gives humans an enormous insight into the present. Using historical analysis in development geography helps to explain why many countries face development challenges, because a country’s history is a huge contributing factor to its level of development.  Often, analysing a country’s history will provide explanations for many of the political, economic, social and environmental factors that also contribute to its level of development. In developing countries of the world today, one of the most significant historical factors that has hindered development is colonisation.

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Colonisation (colonialism):

Colonisation occurs when a country or group of people who wish to control ‘new’ territories form permanent settlements (or colonies) there. It usually involves the large-scale movement of people from the colonising power (also known as the mother or parent country) to the ‘new’ territory (the colony). Colonisation also usually involves the domination of the original inhabitants of the colony (the indigenous population). In most historical cases, colonisation has occurred as a result of the colonising power’s desire to exploit new lands and peoples for their own economic and political gain. Natural resources, agricultural commodities, minerals, plants and spices are some common examples of products that colonising powers throughout history have taken from their colonies. In addition to this, the indigenous populations of colonies have often been forced to work under slave-like conditions for colonising powers. In almost all instances, land has been taken away from indigenous peoples and divided amongst colonial settlers.  This was the case during the Age of Colonialism, which began in the early 16th century, soon after Christopher Columbus first arrived in the Americas. For centuries following this ‘discovery’ in 1492, the European colonial powers of Spain, Portugal, France, England and the Netherlands formed colonies in North, Central and South America, which had a detrimental effect on the indigenous culture and heritage of these regions. At the same time colonisation was occurring in the Americas, the same process was unfolding throughout large sections of Asia and Africa. It is considered an effect of colonisation that today the regions of Asia, Africa and Latin America comprise the least developed countries of the world. With only a few exceptions, such as Ethiopia, Iran, and Thailand (formerly Siam), most of the world’s developing countries were formerly colonies. While formal colonization has largely ended, either through the granting of independence or through wars of liberation, many formerly colonized countries have continued their earlier political-economic relationships with their former colonial master. The reason for this is easy to understand: Colonization involved structuring the economy of the colonized country to serve the needs of the colonizing country and its corporations. Local administrators trained during the colonial period know little else, and therefore the old relationships have continued, only under new leadership. This continuation of earlier colonial political-economic relations is generally referred to as neo-colonialism. Neocolonial relationships have been encouraged by both the International Monetary Fund (IMF) and the World Bank. Both have promoted neoliberal development programs. This neoliberal economic model has resulted in what Kim Scipes’s study of the Philippines from 1962 to 1999 calls “detrimental development” (Scipes 1999).

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What impact did colonialism have on development in the developing world?

Colonialism is defined as the policy of countries extending their powers over other territories. In the 18th and 19th centuries, during the industrial revolution due to industrialization European nations became stronger, therefore they started eyeing the other countries that are rich with natural resources, and the countries that would be good markets for their goods and started occupying them by the process called colonization. They started occupying those countries that have failed to industrialize during the industrial revolution. This process had positive and negative impacts on the development of the colonized territory, it had positive impacts since it often led to modernization of the colony, provided better education, since they opened and established universities, institutions, schools and faculties with European systems of education, and started learning and using foreign languages, also led to the modernization and development of the society due to the interactions between the people from the two different countries and cultures. Clearly the process was not entirely negative. The Europeans brought their laws, education systems and views about civilization in to the colony and helped modernizing their societies; for the most part the Europeans were able to suppress opposition within the countries they ruled. They increased trade, used raw material to feed industries back home, and improved infrastructure by building roads, railways and electricity plants and improving irrigation projects. Distances that once took weeks to cover were covered in days. Schools were built that offered a European-style education. Some were built by the colonizers. But these improvements were spotty and generally didn’t have much effect on the majority of the population. On the other hand colonialism had negative impacts as well, since the powerful countries were using and exploiting the colonized country’s natural resources and they were using them as their markets, the colonized countries found their local economies destroyed or at least dramatically transformed as their populations were forced and used to produce and consumer goods for the country that had colonized them rather for themselves. The population of the colonized country became second class citizens as the people in the other country began to think of themselves as superior and feel it was their duty to civilize and educate the people in the colony. Therefore colonialism in some cases could lead to imperialism (which is defined as the policy of one nation to exercise and use their power over another nation to exploit their resources and use their people as their labor and consumer goods and use their land as their goods market and benefit from every aspect and era of that country). And this often led to the decrease in the development rate of the colony especially economically. Hence imperialism is often considered as “geographical violence.” For example, when Britain occupied India, India had to grow and provide cotton for Britain, then they were shipped to Manchester, England where it was made into finished goods which were sold back to India for a tidy profit. The colonizers also exerted pressure by controlling trade, defining the terms of the trade and forcing the colonies to become indebted to them so they could demand concessions. And most importantly the rise of capitalism, the colonizers owned the production means such as factories farms and work areas and the people from the colonized country were only the workers. There were also cultural traditional and social changes, and more than that, they began using European languages instead of their native language and attended European universities. Therefore it could be argued that it is difficult to state whether the colonization was all a positive or all a negative process in the history of development in the developing countries, since it had both positive and negative impact on the development on the colonized developing countries.

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How Britain become rich nation exploiting India’s economy during its colonial rule:

Britain’s rise for 200 years was financed by its depredations in India. In fact Britain’s industrial revolution was actually premised upon the de-industrialisation of India. India share of the world economy when Britain arrived on its shores was 23 per cent, by the time the British left it was down to below 4 per cent. British rulers destroyed India’s handloom industry and turned the country’s “weavers into beggars”. The handloom weavers were famed across the world whose products were exported around the world, and Britain came right in, broke their looms, imposed tariffs and duties on their cloth and products and started, of course, taking their raw material from India and shipping back manufactured cloth flooding the world’s markets with what became the products of England. That meant that the weavers in India became beggars and India went from being a world famous exporter of finished cloth into an importer.  India also funded both world wars through taxes as well as supplied ammunition and garments. Of Britain’s total World War II debt of 3 billion pounds (in 1945), it owed 1.25 billion pounds to India, and no part of it was ever paid.

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Neo-colonialism:

Neo-colonialism is the geopolitical practice of using capitalism, business globalization, and cultural imperialism to influence a country, in lieu of either direct military control (imperialism) or indirect political control (hegemony). It is the indirect continuation of economic, political and social domination, influenced by colonialism after a country has gained formal independence from colonialism.  The result of neo-colonialism is that foreign capital is used for the exploitation rather than for the development of the less developed parts of the world. Investment, under neo-colonialism, increases, rather than decreases, the gap between the rich and the poor countries of the world. The struggle against neo-colonialism is not aimed at excluding the capital of the developed world from operating in less developed countries. It is aimed at preventing the financial power of the developed countries being used in such a way as to impoverish the less developed. There are numerous examples of the developed countries impeding the growth of single countries or stalling steps for ensuring world stability and security for their own reasons. Furthermore, instruments of debt perpetuation such as the International Monetary Fund (IMF) and the World Bank (WB) give incentives to the underdeveloped countries to fulfil their short run goals by incurring long term debts on a scale that has long crossed the level of pay-ability. Whole economies have been wrecked by such measures taken by the WB and the most disturbing fact is that the motive behind such ‘help’ is not to alleviate the problems of an indebted country but to establish coercive leverage upon it. The government of developing nation is forced, through compliance of economic coercion, to adopt policies that benefit the developed countries, especially the US in the long run. Economic neo-colonialism extracts the human and the natural resources of a peripheral (poor) country to flow to the economies of the wealthy countries at the center of the global economic system; hence, the poverty of the peripheral countries is the result of how they are integrated in the global economic system. Critics of neo-colonialism also argue that investment by multinational corporations enriches few in underdeveloped countries, and causes humanitarian, environmental and ecological devastation to the populations which inhabit the neocolonies whose “development” and economy is now dependent on foreign markets and large scale trade agreements. This, it is argued, results in unsustainable development and perpetual underdevelopment; a dependency which cultivates those countries as reservoirs of cheap labor and raw materials, while restricting their access to advanced production techniques to develop their own economies. One variant of neo-colonialism theory critiques the existence of cultural colonialism, the desire of wealthy nations to control other nations’ values and perceptions through cultural means, such as media, language, education and religion, ultimately for economic reasons.

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B. Political factors that affect development:

The political environment of a country, which is often closely linked to its history, also has a significant impact on its level of development. In general, governments have the power to take actions which direct a country’s social and economic development. In many developing countries with unstable political histories, however, government corruption and greed have caused problems which have hindered such progress.  Wars caused by political tensions – within and between countries – also hinder governments’ abilities to find solutions to development challenges. This is because wars are very costly and cause widespread death and destruction. Wars also often cause disunity amongst the population, which can lead to a breakdown in social cohesion.  Developing countries that lack a stable system of government or those that have experienced (or are experiencing) war, often become burdened with political crises which impede their development. These political problems can sometimes become firmly established and some countries can find it difficult to recover from them.

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1. Government meddling reducing economic growth:

In earlier thinking about development, it was assumed that the market mechanisms of developed economies were so unreliable in developing economies that governments had to assume central responsibility for economic activity. This was to be done through economic planning for the entire economy, which in turn would be implemented by active government participation in the economy and pervasive controls over all private-sector economic activity. Government participation took many forms: Public-sector enterprises were established to manufacture many commodities, including steel, machine tools, fertilizers, heavy chemicals, and even textiles and clothing; government marketing boards assumed monopoly power over the purchase and sale of many agricultural commodities; and government agencies became the sole importers of a variety of goods, and they often became exporters as well. Controls over private-sector activity were even more extensive: Price controls were established for many commodities; import licensing procedures eliminated the importing of commodities not given priority in official plans; investment licenses were required before factories could be expanded; capacity licenses regulated maximum permissible outputs; and comprehensive regulations governed the conditions of employment of workers. The consequence, frequently, was that indigenous entrepreneurs often found it more financially rewarding to devote their energies and ingenuity to the task of procuring the necessary government import licenses and other permits and exploiting the loopholes in government regulations than to the problem of raising the efficiency and productivity of resources. For public-sector enterprises, political pressures often resulted in the employment of many more persons than could be productively used and in other practices conducive to extremely high-cost and inefficient operations. The consequent fiscal burden diverted resources that might otherwise have been used for investment, while the inefficient use of resources dampened growth rates.

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2. Foreign Meddling:

Developing countries have not just economic relationships with Western countries, but also political relationships. This relationship is asymmetric. Foreign countries, notably the US and Europe, or companies from these countries, influence politics in developing countries by

• financing election campaigns

• buying certain political choices from politicians with money

• sponsoring coup-d’états in case of an undesired government

• going to war to remove undesired governments

For some cases of foreign influence, there is concrete evidence. For example, the International Institute for Democracy and Electoral Assistance (IDEA) complains that France supported Yssoufou Mahamadou, the candidate of the PNDS party in Nigeria. France first backed the dictator of Central Africa, then ousted him in 1979, and then granted him asylum in France. The United States helped topple the governments of Cuba (1952), Iran (1953), Brazil (1955), and Pakistan (1977) and helped establish the dictatorship of Augusto Pinochet in Chile (1973). It obtained sovereignty of the Panama Canal, and invaded the country in 1988. The meddling will influence politics in a way that is beneficial to the foreign country, but not necessarily to the developing country. The intervention may impose foreign values or policies, force a dependency upon the developing country, or force an opening of the local market. Notably, foreign countries and companies want mainly their own products sold in the developing country. This, however, suffocates the local economy.

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3. Land Grabbing:

Developing countries and developed countries maintain vivid trade relationships. One source of trade is the exploitation of natural resources and agriculture in the developing country. Foreign investors own large parts of the lands in developing countries.

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Land allocated by large land deals, with proportion of the total land area:

Country Area (ha) % of total
Philippines 5182021 17%
Sierra Leone 1078742 15%
Malaysia 4819483 15%
Benin 1040900 9%
Madagascar 3747741 6%
Cambodia 1139208 6%
Liberia 679000 6%
Indonesia 7527760 4%
Mozambique 2280132 3%
Ghana 669900 3%

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The use of the land is diverse. The land is used to produce crops for export, for biofuel production, for large-scale infrastructure projects, for carbon-credit mechanisms, or simply for speculation. Investor countries are Western countries, but also China, and Arab countries that aim to produce food for their populations.  Large land deals are connected to hopes for benefits for both the investor and the host country. The investor expects productivity and fertility of the land, and a rich source of income. The host country expects fees for land use, income from taxes or customs, job creation for the local population, and the attraction of further foreign investment. In reality, neither the hopes of the investor nor the hopes of the host country always materialize.

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4. Red Tape:

Everybody hates complicated bureaucratic procedures. Bureaucracy is even more cumbersome in developing countries who burden themselves with unnecessary red tape. The World Bank regularly rates the ease of doing business in countries across the world. Factors include, e.g., the number of days needed to start a business, to obtain a construction permit, to employ a worker, to register property, to get credit, and to enforce a contract. Developing countries consistently figure at the bottom of these rankings. In Sub-Saharan Africa, for example, it takes a company twice as many hours to prepare a tax return document as it takes a company in the rich countries. It takes 4 times longer to open a business in Latin America than to open one in the rich countries. The procedure is more expensive and takes more separate bureaucratic steps. It takes twice as long, and is twice as expensive, to register land in Sub-Saharan Africa as it is in the rich countries. Inefficient or excessive bureaucracy can hamper business severely. It not only costs time and money, but it also prolongs the state of legal insecurity between a decision and the completion of an act. This invites bribes and fuels corruption. Finally, red tape discourages business initiative, foreign investment, and the creation of employment.

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C. Economic Factors in Economic Development:

In a country’s economic development the role of economic factors is decisive. The stock of capital and the rate of capital accumulation in most cases settle the question whether at a given point of time a country will grow or not. There are a few other economic factors which also have some bearing on development but their importance is hardly comparable to that of capital formation. The surplus of food grains output available to support urban population, foreign trade conditions and the nature of economic system are some such factors whose role in economic development has to be analyzed:

1) Capital Formation:

Capital is what people use to increase their ability to produce the goods and services they need to improve their living conditions. Physical capital includes plows, warehouses, and irrigation systems, tools, machines, and factories, office buildings, copy machines, telephones, ports, roads, trucks etc.  Human capital is the knowledge and skills that people use to produce goods and services. The strategic role of capital in raising the level of production has traditionally been acknowledged in economics. It is now universally admitted that a country which wants to accelerate the pace of growth, has no choice but to save a high ratio-of its income, with the objective of raising the level of investment. Great reliance on foreign aid is highly risky, and thus has to be avoided. Economists rightly assert that lack of capital is the principal obstacle to growth and no developmental plan will succeed unless adequate supply of capital is forthcoming. Whatever be the economic system, a country cannot hope to achieve economic progress unless a certain minimum rate of capital accumulation is realized. However, if some country wishes to make spectacular strides, it will have to raise its rate of capital formation still higher.

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Education, technical know-how, and human capital in development:

Education is usually universally seen as the means to cure all types of national problems. Better educated people tend to earn more, have fewer children, contribute more to the national economy, are of more use to the government, and are more likely to have educated children. Education for women, in particular, is commonly seen as the most effective means for birth control. The Girl Effect Movement cites a UN study that shows that women who received 7 or more years of education have 2.2 less children on average. On the long run, a country’s economy tends to shift from manufacturing and agriculture to service-oriented and intellectual economic activity. A better educated population is better prepared for this future.  As it became apparent that the physical accumulation of capital was not by itself the key to development, many analysts turned to a lack of education and skills among the population as being a crucial factor in underdevelopment. Numbers of people matter, and so does their training and experience. Human resources are an important factor in economic development. Man provides labour power for production and if in a country labour is efficient and skilled, its capacity to contribute to growth will decidedly be high. The productivity of illiterate, unskilled, disease ridden and superstitious people is generally low and they do not provide any hope to developmental work in a country. Health epidemics such as HIV/AIDS reduce productivity of a nation. In case human resources remain either unutilized or the manpower management remains defective, the same people who could have made a positive contribution to growth activity prove to be a burden on the economy. It has never been, doubted that the level of technical know-how has a direct bearing on the pace of development. As the scientific and technological knowledge advances, man discovers more and more sophisticated techniques of production which steadily raise the productivity levels.  Schumpeter was deeply impressed by the innovations done by the entrepreneurs, and he attributed much of the capitalist development to this role of the entrepreneurial class. A well-developed entrepreneurial class, motivated and trained to organize resources for efficient production, is often missing in poor countries. The cause may be that managerial positions are awarded on the basis of family status or political patronage rather than merit, it may be the prevalence of economic or cultural attitudes that do not favour acquisition of wealth by organizing productive activities, or it may simply be an absence of the quantity or quality of education or training that is required. In today’s world, much production is knowledge-intensive, thus putting a premium on a well-educated workforce. The abilities to read, to do basic calculations, to operate electronic equipment, and to follow relatively complex instructions are important requirements for much modern labour. Failure to develop such essential labour skills can be an important cause of lack of growth. Poor health is another source of inadequate human resources. When the labour force is healthy, less working time is lost, and more effective effort is expended. Poor countries have low allocation of budget onto education & health sector. This is due to three factors. Firstly, falling export revenue of agriculture produce due to various import restrictions from developed countries e.g. CAP (Common Agriculture Policy). Secondly, large proportion of national income was devoted to service debts to IMF & World Bank. Thirdly, these financial institutions imposed various austerity measures as a condition for rescheduling of loans. Low spending on education means many will not know how to read, write, perform basic arithmetic, operate electronic equipment & to take complex instructions. Lesser availability of healthcare means lower life expectancy, more days taken off as leave resulting in lower output & loss of workforce at productive age etc. Since technology has now become highly sophisticated, still greater attention has to be given to Research and Development for further advancement. Under assumptions of a linear homogeneous production function and a neutral technical change which does not affect the rate of substitution between capital and labour, Robert M. Solow has observed that the contribution of education to the increase in output per man hour in the United States between 1909 and 1949 was more than that of any other factor. No nation can develop in spites of its natural endowment if such nation does not take seriously human capital development which could be derived through sound academic foundation that is tailored towards a good cradle of nursery, primary and secondary school. Our major focus should be in the education sector because it is the education sector that produces the human capital that is needed to develop other industries of the whole nation. Before a nation could be referred to as developed, it must have developed people that can think for the country.

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2. Natural Resources:

The principal factor affecting the development of an economy is the natural resources. Among the natural resources, the land area and the quality of the soil, forest wealth, good river system, minerals and oil-resources, good and bracing climate, etc., are included. For economic growth, the existence of natural resources in abundance is essential. Countries naturally rich in coal and oil, for example, do not need to spend money on importing these resources, which are used to produce energy. When exported, natural resources also generate wealth for countries, which means that money can then be spent on other, new industries. Countries with well-developed industries are able to provide jobs, infrastructure and services for their populations, which increase the overall quality of life of their citizens. A country deficient in natural resources may not be in a position to develop rapidly. In fact, natural resources are a necessary condition for economic growth but not a sufficient one. Japan and India are the two contradictory examples. According to Lewis, “Other things being equal man can make better use of rich resources than they can of poor”. In less developed countries, natural resources are unutilized, under-utilized or mis- utilized. This is one of the reasons of their backwardness. This is due to economic backwardness and lack of technological factors. According to Professor Lewis, “A country which is considered to be poor in resources may be considered very rich in resources some later time, not merely because unknown resources are discovered, but equally because new methods are discovered for the known resources”. Japan is one such country which is deficient in natural resources but it is one of the advanced countries of the world because it has been able to discover new use for limited resources. One of the populist policies following the Mexican Revolution early in the twentieth century was the redistribution of land from large landowners to ordinary peasants. Today, however, fragmented land ownership prevents Mexican agriculture from producing at costs low enough to compete in international markets. The Mexican government now faces an agonizing choice between allowing its populist land reforms to be reversed or continuing to protect a large agricultural sector whose inefficiency is increasing relative to competing suppliers. Although abundant supplies of natural resources can assist growth, they are neither sufficient to ensure growth nor necessary for it. Some countries with large supplies of natural resources have poor growth performance because the economic structure encourages waste. Prime examples are the former Soviet Union, Argentina before the 1990s, and Uganda. In contrast, other countries have enjoyed rapid rates of economic growth based on human capital and entrepreneurial ability despite a dearth of natural resources. Prime examples are Switzerland in earlier centuries, Japan over the past 100 years (until its significant current economic malaise, beginning in the early 1990s), and Singapore, Hong Kong, and Taiwan since the end of the Second World War. Inefficiently managed resource is the hallmark of poor nations. Many poor countries do not achieve both productive & allocative efficiency. Productive inefficiency exists due to absence of competition, contracts & projects are awarded to family members or political patronage, government adopting a close economy policy etc. Allocative inefficiency persists as factors of production like labor & capital are used to produce too much of something & too few of something else. As such someone else can still be made better off without making someone else worse off. For e.g. Indian government was being criticised for encouraging the production of oilseeds & sugar cane where it has no comparative advantage. It should concentrate on rice, wheat & cotton. A third kind of inefficiency, called X-inefficiency, occurs either when firms do not seek to maximize their profits or when owners of the factors of production do not seek to maximize their well-being. Like allocative and productive inefficiency, X-inefficiency also puts the economy inside its production possibilities boundary. Professor Harvey Liebenstein of the University of California, the economist who developed the concept, has studied X-inefficiency in developing countries. He cites psychological evidence to show that non-maximizing behaviour is typical of situations in which the pressure that has been placed on decision makers is either very low or very high. According to this evidence, if the customary living standard can be obtained with little effort, people are likely to follow customary behaviour and spend little time trying to make optimal decisions that would improve their well-being. When pressure builds up, so that making a reasonable income becomes more difficult, optimizing behaviour becomes more common. Under extreme pressure, however, such as very low living standards or a rapidly deteriorating environment, people become disoriented and once again do not adopt optimizing behaviour.

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3. Agriculture:

A developing country whose labour force is mainly devoted to agriculture has little choice but to accept this basic allocation of resources. It can build up its industrial sector, and if its efforts are successful, the proportion of the population devoted to urban pursuits will rise. But the change will come slowly, leaving a large portion of the country’s resources in rural pursuits for a long time to come. It follows that policies to help the agriculture sector raise productivity are an important part of the development strategy in any agriculture-based poor country. These can fill the dual purposes of raising incomes of rural workers and reducing the cost of food for urban workers. A developing country’s government may choose to devote a major portion of its resources to stimulating agricultural production, say, by mechanizing farms, irrigating land, using new seeds and fertilizers, and promoting agricultural research and development. Modern developments of new crops and new growing techniques put a premium on agricultural research and development (R&D) so that a country can adopt, and usually adapt, other country’s agricultural innovations. Also, nonfood agricultural and forest products are becoming increasingly important, and R&D expenditures are often needed if these are to become established products. If successful, the country will stave off starvation for its current population, and it may even develop an excess over current needs and thus have a crop available for export. A food surplus can earn foreign exchange to buy needed imports. The gains from this strategy, while large at first, are subject to diminishing returns. Further gains in agricultural production have an ever-higher opportunity cost, measured in terms of the resources needed to irrigate land and to mechanize production. Critics of reliance on agricultural output argue that developing economies must start at once to develop other bases for economic growth. Many developing countries (as well as many developed ones) suffer from misguided government intervention in the agriculture sector. In India, for example, the government— motivated by a desire to diversify agricultural production by increasing the number of crops under cultivation—has encouraged crops such as oilseeds and sugarcane, in which India has a comparative disadvantage, and discouraged crops such as rice, wheat, and cotton, in which India has a strong comparative advantage. It has subsidized food prices, thus giving large benefits to the urban population. The term ‘marketable surplus’ refers to the excess of output in the agri­cultural sector over and above what is required to allow the rural population to subsist. The importance of the marketable surplus in a developing economy emanates from the fact that the urban industrial population subsists on it. With the development of an economy, the ratio of the urban population increases and increasing demands are made on agriculture for food grains. These demands must be met adequately; otherwise the consequent scarcity of food in urban areas will arrest growth. In case a country fails to produce a sufficient marketable surplus, it will be left with no choice except to import food grains which may cause a balance of payments problem

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4. Conditions in Foreign Trade:

The classical theory of trade has been used by economists for a long time to argue that trade between nations is always beneficial to them. In the existing context, the theory suggests that the presently less developed countries should specialize in production of primary products as they have comparative cost advantage in their production. The developed countries, on the contrary, have a comparative cost advantage in manufactures including machines and equipment and should accordingly specialize in them. In the recent years, a powerful school has emerged under the leadership of Raul Prebisch which questions the merits of unrestricted trade between developed and under-developed countries on both theoretical and empirical grounds. Foreign trade has proved to be beneficial to countries which have been able to set-up industries in a relatively short period. These countries sooner or later captured international markets for their industrial products. Therefore, a developing country should not only try to become self-reliant in capital equipment as well as other industrial products as early as possible, but it should also attempt to push the development of its industries to such a high level that in course of time manufactured goods replace the primary products as the country’s principal exports. In countries like India the macro-economic interconnections are crucial and the solutions of the problems of these economies cannot be found merely through the foreign trade sector or simple recipes associated with it.

 

5) Economic System:

Two fundamental obstacles to development:

1. How to adopt the right policies

2. How to find sufficient funds

The economic system and the historical setting of a country also decide the development prospects to a great extent. There was a time when a country could have a laissez faire economy and yet face no difficulty in making economic progress. Laissez-faire is an economic system in which transactions between private parties are free from government interference such as regulations, privileges, tariffs, and subsidies. The phrase laissez-faire is part of a larger French phrase and literally translates to “let (it/them) do”, but in this context usually means to “let go”. In today’s entirely different world situation, a country would find it difficult to grow along the laissez-faire path of development. The Third World countries of the present times will have to find their own path of development. They cannot hope to make much progress by adopting a laissez faire economy. Further, these countries cannot raise necessary resources required for development either through colonial exploitation or by foreign trade. They now have only two choices before them:

i) They can follow a capitalist path of development which will require an efficient market system supported by a rational interventionist role of the State.

ii) The other course open to them is that of economic planning.

The latest experiments in economic planning in China have shown impressive results. Therefore, from the failure of economic planning in the former Soviet Union and the erstwhile East European socialist countries it would be wrong to conclude that a planned economy has built-in inefficiencies which are bound to arrest economic growth.

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Fiscal policy for developing nations:

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6. Domestic Saving:

Although modern development strategies call in many instances for a large infusion of imported foreign capital, the rise of domestically owned firms, which will reap some of the externalities created by foreign technology, is one key to sustained development. This requires a supply of domestic saving to finance their growth. If more domestic capital is to be created at home by a country’s own efforts, resources must be diverted from the production of goods for current consumption. This reallocation of resources implies a reduction in current living standards. If living standards are already at or near the subsistence level, such a diversion will be difficult. At best, it will be possible to reallocate only a small proportion of resources to the production of capital goods.

Shortage of savings:

Given the broad relationship between capital accumulation and economic growth established in growth theory, it was plausible for growth theorists and development economists to argue that the developing countries were held back mainly by a shortage in the supply of capital. These countries were then saving only 5–7 percent of their total product, and it was manifest (and it remains true) that satisfactory growth cannot be supported by so low a level of investment. It was therefore thought that raising the savings ratio to 10–12 percent was the central problem for developing countries. Early development policy therefore focused on raising resources for investment. Steps toward this end were highly successful in most developing countries, and savings ratios rose to the 15–25 percent range. However, growth rates failed even to approximate the savings rates, and theorists were forced to search for other explanations of differences in growth rates. It has become increasingly clear that there can be much wastage of capital resources in the developing countries for various reasons, such as wrong choice of investment projects, inefficient implementation and management of these projects, and inappropriate pricing and costing of output. These faults are particularly noticeable in public-sector investment projects and are one of the reasons why the Pearson Commission Report of the International Bank for Reconstruction and Development (1969) found that “the correlation between the amounts of aid received in the past decades and the growth performance is very weak.” But even in the private sector there may be a considerable distortion in the direction of investment induced by policies designed to encourage development. Thus, in most underdeveloped countries, a considerable part of private expansion investment, both foreign and domestic, has been diverted into the expansion of the manufacturing sector, catering to the domestic market through various inducements, including tariff protection, tax holidays, cheap loans, and generous foreign-exchange allocations granting the opportunity to import capital goods cheaply at overvalued exchange rates. As a consequence, there developed a very considerable amount of excess capacity in the manufacturing sector of the underdeveloped countries pursuing such policies.

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7. Infrastructure:

Key services, called infrastructure, such as transportation and a communications network, are necessary for efficient commerce. Roads, bridges, railways, and harbours are needed to transport people, materials, and finished goods. Phone and postal services, water supply, and sanitation are essential to economic development. The absence of a dependable infrastructure can impose severe barriers to economic development. Many governments feel that money spent on a new steel mill shows more impressive results than money spent on such infrastructure investments as automating the telephone system. Yet private, growth-creating entrepreneurial activity will be discouraged more by the absence of good telephone communications than by the lack of domestically produced steel. Due to the burden of debt & austerity measures imposed onto many developing countries, infrastructure development is far left behind. Nothing much has been done to improve the telecommunication & transportation which are key services that will attract foreign investment. Roads, bridges, harbours & railways are in bad condition & may affect the timely delivery of goods. The IMF & World Bank are not to be fully blamed for all the economic mess in developing countries. While it is true that austerity measures had played some role in putting poor countries in tighter condition, the recipients of aid must shoulder the blame too. It is not uncommon to hear that some corrupt country leaders had siphoned those monies into their own account, use it for political agenda etc. Also it depends on their prudence on using the fund provided.

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8. Foreign Debt:

Many developing countries of the world are heavily indebted (owing money) to international financial institutions and foreign banks based in developed countries. The debt these countries are facing today is a result of large loans that were issued to them during the 1960s and 1970s. While these loans initially came attached with low interest rates, over time the banks which lent out the money have increased the interest rates on repayments. In most cases, interest rates have been increased to levels which are near impossible for developing countries to meet. In this way, debts continue to accumulate, and the money which could be spent by governments on such things as infrastructure and healthcare is spent on repaying debts. Another factor which has exacerbated both the debt crisis and economic challenges in general in many developing countries is government corruption. Some of the countries which borrowed money from foreign creditors or international banks, for example, have since undergone periods of dictatorial rule. During these periods, some leaders have laundered public money instead of repaying their country’s debt.  Debt has crippled many developing countries. Often based on loans taken out by prior rulers and dictators (many of which various Western nations put into power to suit their interests), millions face poorer and poorer living standards as precious resources are diverted to debt repayment.

The Scale of the Debt Crisis:

Total debt continues to rise, despite ever-increasing payments, while aid is falling. For example:

•The developing world now spends $13 on debt repayment for every $1 it receives in grants.

•For the poorest countries (approximately 60), $550 billion has been paid in both principal and interest over the last three decades, on $540bn of loans, and yet there is still a $523 billion dollar debt burden.

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9. Foreign exchange shortages:

With high levels of protection for domestic industry, and with exchange rates that were often maintained at unrealistic levels (usually in an effort to make imported capital goods “cheap”), the experience of most developing countries was that export earnings grew relatively slowly. The simultaneously sharp increase in demand for imported capital goods (and for raw materials and replacement parts as well) resulted in unexpectedly large increases in imports. Most developing countries found themselves with critical foreign-exchange shortages and were forced to reduce imports in order to cut their current-account deficits to manageable proportions. The cutbacks in imports usually resulted in reduced growth rates, if not recessions. This result led to the view that economic stagnation was caused primarily by a shortage of foreign exchange with which to buy essential industrial inputs. But over the longer term the growth rates of countries that continued to protect their domestic industries heavily not only stagnated but declined sharply. Contrasting the experience of countries that persisted in policies of import substitution with those that followed alternative policies subsequently demonstrated that foreign-exchange shortage was a barrier to growth only within the context of the protectionist policies adopted and was not inherently a barrier to the development process itself.

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10. Globalisation and the free market economy:

The process of globalisation has significantly changed the nature of how countries of the world trade their goods with one another. The free market system of international trade, while benefiting the economies of most developed countries of the world, has adversely affected the economies of many developing countries. One way in which the global free trade market has done this is through the introduction of reduced protective tariffs and increased exclusionary trading blocs. Tariffs are a form of tax placed on foreign goods that arrive in a country. When a tariff is placed on an imported product, the price of that product in the receiving country will be higher and consumers will therefore be less likely to purchase it. Sometimes countries place tariffs on goods which they produce domestically for protective reasons. Even though tariffs are often designed to protect local producers, they contradict the principles of the free market economy. Proponents (advocates) of free trade believe tariffs are harmful and free trade bodies, such as the World Trade Organisation (WTO), endeavour to eliminate tariffs entirely. The introduction of free trade principles and the reduction of tariffs in developing countries have, however, already adversely affected millions of poor people around the world. Globalisation has led to a rise in powerful transnational corporations, which often outsource their labour to countries where workers are exploited. However, globalisation does help development of developing nations and it is discussed later on in this article.

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11. War and Civil War:

When watching the news, it seems that most military conflicts happen in poor countries. The developing countries are plagued more than average by war, civil war, and ethnic strife.  Wars and conflicts severely hamper the progress of a country. Wars kill people, induce human suffering, destroy homes, and damage infrastructure and equipment. They also bind resources that might find better uses elsewhere.

Military spending as % of GDP:

Country % of GDP Country % of GDP
S. Arabia 11.2 Djibouti 3.7
Oman 9.7 Namibia 3.7
UAE 7.3 Colombia 3.7
Timor Leste 6.8 Bahrain 3.7
Israel 6.3 Kyrgyzstan 3.6
Chad 6.2 Chile 3.5
Jordan 6.1 Sri Lanka 3.5
Georgia 5.6 Morocco 3.4
Iraq 5.4 Sudan 3.4
USA 4.7 Ecuador 3.4
Kuwait 4.4 Azerbaijan 3.4
Singapore 4.3 Greece 3.2
Russia 4.3 Swaziland 3.1
Angola 4.2 Brunei 3.1
Armenia 4.2 Botswana 3.0
Lebanon 4.1 S. Korea 2.9
Syria 4.0 Ukraine 2.9
Yemen 3.9 Lesotho 2.8
Algeria 3.8 India 2.8
Burundi 3.8 Pakistan 2.8
Mauritania 3.8 Turkey 2.7

Many poor nations have a high military spending. The Stockholm International Peace Research Institute regularly estimates the amount of money that countries invest in military equipment. Among the top 40 spenders by percentage of their GDP, only 3 are high-income nations (the US, Israel, and Greece). The remainder is roughly equally split between the Middle East, Africa, and the remainder of Asia. In particular, the list contains some of the poorest nations of the world. These numbers indicate that these countries attach a larger relative importance to the military than the rest of the world. This is surprising, since one would expect that these countries would need as many resources as possible to fight poverty, to build up education, and to support their economy. People argue that historical boundaries should be kept. Yet, the benefit of keeping historical boundaries is not clear, in particular if populations have changed since the borders have been defined, or if the historical boundaries do not correspond to ethnic boundaries. It is people who define boundaries, not boundaries that define people. India and Pakistan have fought many wars and spent enormous amount money over Kashmir, all in the end preventing development of these nations. Developing countries have to learn from developed nations how to solve territorial dispute and rights of self-determination. In Canada, e.g., the region of Quebec has repeatedly staged referendums to decide whether the region should stay with the main land or not. So far, the official result is that the majority has voted to stay with Canada. In the United Kingdom, Scotland is debating an exit from the country. In both cases, it is out of question that the mainland invades the region with military force to prevent secession. Most likely, a wish to secede will just be respected. Northern Ireland seems a violent exception to this rule. Yet, it is not. The current status in Northern Ireland is based on an 1998 agreement between the United Kingdom, Northern Ireland, and the Republic of Ireland. The agreement states that Northern Ireland shall belong to whatever country the majority of its population prefers. So far, the majority of people in Northern Ireland is in favor of staying in the UK. It remains to hope that other countries handle the question of separation as democratically and peacefully as these countries.

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12. Poverty:

Poverty is a state or condition in which a person or community lacks the financial resources and essentials to enjoy a minimum standard of life and well-being that’s considered acceptable in society. Poverty rates are an important statistics to follow to a global investor as a high poverty rate is often indicative of larger scale issues within the country in question. Poverty is the principal cause of hunger. The causes of poverty include poor people’s lack of resources, an extremely unequal income distribution in the world and within specific countries, conflict, and hunger itself. As of 2015 (2011 statistics), the World Bank has estimated that there were just over 1 billion poor people in developing countries who live on $1.25 a day or less.  Progress in poverty reduction has been concentrated in Asia, and especially, East Asia, with the major improvement occurring in China. In Sub-Saharan Africa, the number of people in extreme poverty has increased.

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Poverty trap:

Countries stuck in destitution because of weak institutions put in place by colonial overlords, or because of climates that foster disease, or geographies that limit access to global markets, or simply by the fact that poverty is overwhelmingly self-perpetuating. Apparently the trap can be escaped.

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Circle of poverty:

Because a country has little capital per head, it is poor; because it is poor, it can devote few resources to creating new capital rather than to producing goods for consumption; because little new capital can be produced, capital per head remains low, and the country remains poor. The vicious circle can be made to seem an absolute constraint on growth rates. Of course, it is not; if it were, we would all still be at the level of the early agricultural civilizations. The grain of truth in the vicious-circle argument is that some surplus must be available somewhere in the society to allow saving and investment. In a poor society with an even distribution of income, in which nearly everyone is at the subsistence level, saving may be very difficult. But this is not the common experience. Usually there is at least a small middle class that can save and invest if opportunities for the profitable use of funds arise.

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Absolute poverty:

Absolute poverty refers to being unable to afford basic human needs, such as clean and fresh water, nutrition, health care, education, clothing and shelter. About 1.7 billion people are estimated to live in absolute poverty today.

Relative poverty:

Relative poverty refers to the lacking a usual or socially acceptable level of resources or income as compared with others within a society or country. What is considered ‘acceptable’ inevitably various from country to country and is significantly higher in developed countries than in developing countries. The common international poverty line has in the past been roughly $1 a day. However in 2008, the World Bank revised this figure to $1.25 at 2005 purchasing-power parity (PPP).

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About a third of the world lives on less than $2 a day. The poorest half of the world – 3.5 billion people – own only 0.71% of the world’s wealth between them. A billion people live in chronic hunger. Nearly a third of all children are chronically malnourished, which unless addressed before the age of two often leaves them stunted and mentally impaired.  A sixth of the world’s adults can’t read or write and many more have only rudimentary literacy. Sub-Saharan Africa has only two doctors for every 10,000 people, which is partly why on average its inhabitants live to an average age of 56. Most countries aren’t well-off. The World Bank data shows that most countries have a relatively low level of national income per capita. 120 nations earn less per person than the world average. Everybody seems to be wittering on about the Asian Century these days – and Asian development has been miraculous. But about 69% of Indians live on less than US$2 per day: 850 million people. A third of Chinese, 400 million, remain similarly poor despite the country’s amazing success in reducing poverty. Together those two countries contain more poor people than there are Africans. Rather than a term like “developing” to describe these people and countries, the travel writer Dervla Murphy’s phrase “majority world” is more accurate.

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Myth: We need economic growth to eradicate poverty.

Fact: One of the first things the growth lobby will say if you criticize economic growth is that you are condemning the poor to eternal poverty. Not true – anyone interested in poverty eradication would advocate a re-distribution of wealth. There is enough wealth in the world for everyone to live comfortably – it’s just that most of it is in the hands of a tiny minority. Sharing and a fair distribution of resources will alleviate poverty, not growth. We’ve had 200 years of growth and although some people have been lifted out of poverty, concentration of wealth and power means that there are now more poor people in the world than ever before. There is a case for economic growth in poor countries but economic growth does not necessarily eliminate poverty. India has achieved great economic growth but due to population explosion, corruption and poor governance, one third of the population lives below poverty line. Although the world’s economy has grown 5 times since 1950 there are arguably more people in absolute poverty today than there were then.

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Energy poverty and development:

Today, 1.5 billion people live without electricity, a situation known as energy poverty. For them, life still moves to the patterns of the sun and the moon. Work and study mostly come to an end when the sun goes down. Cooking happens the way it has for centuries before – over smoky indoor fires that do no favors for lungs or life expectancies. In Binika, Kurdistan, “the village pools their money to run a community generator one or two hours each day.” The generator cannot power heavy appliances or machinery. “While satellite dishes and televisions are cheap in the area, fuel for a generator is ‘very expensive.’”   Energy poverty reaches beyond the villages of developing countries. The lengthy economic downturn has created new classes of energy poor in advanced economies. In Solihull, England, Richard has, “gone four years without heat and dares not turn his lights on for fear of increasing the severe debt” to his energy company. Charting the HDI against the yearly electric consumption per capita, A. Pasternak observes that 4,000 kWh per capita constitutes a threshold. The reasons for choosing 4,000 kWh are the following. No country with an electric consumption below 4,000 kWh has an HDI above 0.9 and, barring four cases (South Africa, Saudi Arabia,  Russia and South Korea), all countries consuming more than this value per capita have an HDI greater than 0.9. Neither the Human Development Index nor the Gross Domestic Product of developing countries will increase without an increase in electricity use.

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D. Social and cultural factors in Economic Development:

1. Social Organisation:

Mass participation in development programs is a pre-condition for accelerating the growth process. However, people show interest in the development activity only when they feel that the fruits of growth will be fairly distributed. Experiences from a number of countries suggest that whenever the defective social organisation allows some elite groups to appropriate the benefits of growth, the general mass of people develop apathy towards State’s development programs. Under the circumstances, it is futile to hope that masses will participate in the development projects undertaken by the State. India’s experience during the whole period of development planning is a case in point. Growth of monopolies in industries and concentration of economic power in the modern sector is now an undisputed fact. Furthermore, the new agricultural strategy has given rise to a class of rich peasantry creating widespread disparities in the countryside.

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2. Corruption:

Transparency International’s definition of corruption is: “the abuse of entrusted power for private gain”. This can mean not only financial gain but also non-financial advantages. Corruption is rampant in developing countries at various levels and it operates as a negative factor in their growth process. Until and unless these countries root-out corruption in their administrative system, it is most natural that the capitalists, traders and other powerful economic classes will continue to exploit national resources in their personal interests. The regulatory system is also often misused and the licenses are not always granted on merit. The art of tax evasion has been perfected in the less developed countries by certain sections of the society and often taxes are evaded with the connivance of the government officials. An estimated one trillion US dollars get siphoned off through bribes every year according to the World Bank. Corruption can take many forms that vary in degree from the minor use of influence to institutionalized bribery.

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Global Corruption, as compiled by Transparency International shows that corruption is less in developed nations and more in developing nations. The majority of citizens in the West have never bribed an official. The majority of people in developing countries did.

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Corruption has a devastating effect on the country. This is because corruption makes government officials do something for their own interest that is against the interest of their country. Moreover, corruption eradicates the trust in the law and the government.  Corruption also reinforces itself. Once the majority of people are corrupt, the ones who are not are disadvantaged. Hence, as soon as a critical mass of people is corrupt, the rest is likely to follow.  We might think that the bad government services force people to pay bribes. Yet, the bad government services are themselves operated by people from developing country. Policemen, civil servants, public officials, and military people who demand bribes are all part of the society. Thus, both bribe payers and bribe receivers are just the people themselves. It appears that corruption is an illness that is deeply rooted in the society. Whoever does not take part, will finally just be disadvantaged. Therefore, most people participate. This may make corruption part of the general culture. In the worst case, people would no longer regard corruption as evil, but as part of life. Corruption may be facilitated by a larger inequality of income in the developing countries. If a policeman earns a few dollars per month, but a business owner makes thousands of dollars per month, then it is very easy and tempting for the businessman to hand over a few dollars to the policeman. Corruption is a cheap solution. It also makes money trickle down to the less well-paid professions. Another big contributor of corruption may be organized crime and drug cartels. These organizations typically have financial power that exceeds that of the ordinary population by orders of magnitude. The government may also play its part. A general public tolerance of corruption, the lack of a culture of transparency, and a slow and cumbersome legal system that hinders the ability to successfully prosecute cases promote corruption. Corruption is a significant problem for all nations, but it can hugely undermine societies where complex systems of governance and scrutiny have yet to be put in place. It strikes at four levels.

•Funds are stolen and taken overseas, often at levels which are comparable with net investment. Executive power is abused to raise loans, where default either precipitates a banking crisis or leads to unsustainable overseas debt.

•Decisions are taken on poor grounds: bridges are built where they are not needed. Such ‘pork’ projects are almost never given maintenance funding. Nepotism is commonplace: relations are promoted to jobs which they are unable to perform satisfactorily. Ethnic groups come to dominate key ministries and other areas, such as the military, which they then exploit for sectarian purposes.

•The population lose trust in civil society: law is for the wealthy, the state is a predator, the police and the bureaucrats sell permissions to operate and come into the average life in order to extract a fee.

•Tax evasion impoverishes the state, and regulatory evasion cripples its capacity to direct and operate.

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Corrupt elite and Observance of the Rule of Law:

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The figure above shows that rule of law is obeyed mainly in developed nations:

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A country is governed mostly by its elite: politicians, bureaucrats and businessmen. In developing countries, these elite does not always act responsibly. The government does not function the way it should function, it does not provide a reliable law and a reliable implementation of it, and the administration and judiciary do not work the way they should.  As an example, take the use of money for the poor. As the Economist noted in 2010, “70% of the money allocated for drugs and supplies by the Ugandan government in 2000 was lost to ‘leakage’; in Ghana, 80% was siphoned off. In India only 16% of the resources earmarked for the poor under the country’s subsidized food distribution scheme ever reached them.”  If the government cannot or does not guarantee the rule of law, then the very basics of trade, economy, and justice are under threat. If a merchant cannot trust that a business partner who does not fulfil his obligations will be put to justice, then he has to take potential losses into account when making business. If a company cannot trust on laws and their implementation, then it cannot make long-term investments. If people see that those who do not follow the law prosper, they will themselves start deviating from the law.  If the ruling elite uses its power mainly to reinforce its own position, then the country cannot progress. Since it is the elite who makes and implements laws, it is difficult to make and implement laws that fight against corrupt elite.

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Foreign Corruption:

Transparency International report of 2009 states that “large numbers of multinational corporations from the richest nations are pursuing a criminal course to win contracts”. One recent example was the case of Siemens, which bribed several governments around the world, as reported by the New York Times. Siemens “used bribes and kickbacks to foreign officials to secure government contracts for projects like a national identity card project in Argentina, mass transit work in Venezuela, a nationwide cellphone network in Bangladesh and a United Nations oil-for-food program in Iraq under Saddam Hussein”. In total “the company paid an estimated 1.4 billion US dollars in bribes to government officials in Asia, Africa, Europe, the Middle East and Latin America”. Most Western countries had no law against giving bribes to foreign officials. A state contract obtained by corruption always indicates that the contract went to a company that offers a suboptimal cost/benefit ratio. Thus, the developing country suffers an economic disadvantage by making a contract based on a bribe. It can also happen that the state contract would not have been made at all, if it were not for the bribe. In these cases, the bribe wastes public money and makes things happen that are not in the interest of the country. Furthermore, state contracts usually come with large amounts of money. They also often come with long-lasting follow-up engagements. Thus, the state contract would secure long-lasting employment for locals, if it went to a local company. It would also help build up local know-how and create a sustainable local industry. If the contract goes to a foreign company instead, these advantages are sacrificed. This does not mean that local companies should be favoured on principle over foreign companies. It just means that an illegal bias towards foreign companies through corruption will hurt the local economy.

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Corruption and poor nations:

Although corruption is a global phenomenon found in all countries – but evidence shows it harms poor people more than others, stifles economic growth and diverts desperately needed funds from education, healthcare and other public services. Nations with the highest risk of corruption are often the desperately poor, where foreign aid and assistance can easily be transferred through back channels of oppressive regimes. As a result, the impact of corruption can extend well beyond any economic detraction to affect the quality of life for millions of citizens. Corruption is the single greatest obstacle to economic and social development. Corruption is a major cause of many human rights abuses.  Not all poor countries are corrupt. Corruption tends to be more obvious in some poor countries because the police aren’t very good, the rule of law isn’t established and small-scale bribery may have become entrenched, but a country isn’t necessarily poor because the wealth has all been stolen. All sorts of other more important reasons explain poverty, like political instability, bad economic policy, colonial history, an over-reliance on tropical commodities, distance from major markets, being landlocked and poor health and education. Corruption doesn’t necessarily cause poverty: that’s like blaming poor countries for their own failures. In some cases quite the reverse can be true. Nicholas Shaxson’s excellent book Treasure Islands suggests that Transparency International’s corruption perceptions index has things the wrong way round: we should rank countries on banking secrecy, not graft. The real economic issue is that rich nations harbour ill-gotten spoils, not that Charles Taylor foists himself on Liberia. Relatively un-corrupt poor countries include Vanuatu, Fiji, Kiribati, Tuvalu, Samoa, Tonga, the Federated States of Micronesia, Bhutan, Cape Verde and Mauritius.

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3. Desire to Develop:

Development activity is not a mechanical process. The pace of economic growth in any country depends to a great extent on people’s desire to develop. If in some country level of consciousness is low and the general mass of people has accepted poverty as its fate, then there will be little hope for development. According to Richard T. Gill, “The point is that economic development is not a mechanical process; it is not a simple adding- up of assorted factors. Ultimately, it is a human enterprise. And like all human enterprises, its outcome will depend finally on the skill, quality and attitudes of the men who undertake”.

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4. Women empowerment:

Why is empowerment of women in developing countries important, and what effect does their empowerment have on development?

–Evidence shows that expanding opportunities for girls and women not only improves their positions in society, but it also has a major impact on the overall effectiveness of development. Evidence also shows that when women and men are relatively equal, economies tend to grow faster, the poor move more quickly out of poverty, and the well-being of men, women, and children is enhanced. Studies show that the education of mothers improves the health of their children and lowers the fertility rate. Studies also show that when women have more control over the family’s income or productive assets, the family’s overall situation improves.

–In Brazil, income in the hands of mothers has four times the impact on children’s height-for-age as income in the hands of fathers.

–In Sub-Saharan Africa, a large proportion of women are farmers. If women could participate in agriculture on an equal basis with men, total agricultural output could increase by up to 20 percent.

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5. Population Growth:

Population growth is one of the central problems of economic development. Some developing countries have population growth rates in excess of their GDP growth rates and therefore have negative growth rates of per capita GDP. Many developing countries have rates of population growth that are nearly as large as their rates of GDP growth. As a result, their standards of living are barely higher than they were 100 years ago. They have made appreciable gains in aggregate income, but most of the gains have been literally eaten up by the increasing population.

High Fertility Rate:

A large fertility rate has not only consequences on malnutrition. It seems that it also has a consequence on education. If it is hard for the parents to send 1 child to school, it is harder to send 5 children to school. If it is hard to find university scholarships for thousands of students, it is harder to find scholarships for tens of thousands of students. If people cannot be sent to school or university, they lose out in today’s world.  In other words, the exorbitant growth of population seems to have outpaced the resources and infrastructure that the countries provide. A high fertility rate will lead to a large working force, and may thus ultimately benefit the local economy. This phenomenon is known as the demographic dividend. Yet, this dividend can pay off only when the fertility rate decreases at some point of time. If it does not decrease, then the needy part of the population will always be larger than the working-age part of the population. There are two reproduction strategies, the R-selection (which produces lots of offspring and invests little in them), and the K-selection (which produces less offspring, but takes more care of them). While the R-selection produces more children, the K-selection produces more competitive children i.e. Children, grand-children, and great-grand children alike get better marks at school, are more likely to go to university and have higher incomes as adults. Therefore, as child mortality decreases, the advantages of R-selection have decreased, while the advantages of K-selection become more prevalent as the society values education more.

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As you can see in the figure, stabilization ratio in developed nations has fallen from more than 2 to less than 1.  A lack of government spending on promoting contraception (prevention of pregnancy) in some developing countries has seen birth rates rise considerably. High birth rates in developing countries exacerbate problems related to poverty, as often these countries do not have the social or economic stability to support such a large population. It should be noted, however, that people’s decisions not to use birth control are often also cultural and/or religious.

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6. Culture:

Cultural values may hinder or accelerate human progress. Having good climate, good natural resources, and good policy advice may not be enough to make a nation succeed. Scholars are now looking seriously at the role of having a good culture for improving prospects for national prosperity. At the end of World War II, much of Western Europe and Japan lay in ruins. Yet, today these regions are once more among the richest and most powerful on earth. Marshall Plan money and America’s benevolent example and protection get much of the credit for these postwar economic miracles. But massive aid and well-intentioned guidance have not produced comparable results in Latin America, Africa, and elsewhere including pockets of poverty within the highly developed nations themselves. Why not? What went wrong? Geography and history alone do not explain why some countries flourish and others lag behind. In 1960, for example, the economies of South Korea and Ghana were roughly equal; today, only Korea has developed into a global economic power. Even within nations different areas develop unevenly. Northern Italy, for example, has prospered more than the south, and certain minorities within the U.S. population remain relatively poor. Sociologists and scholars now look for other factors to explain obvious differences in development among nations and within them. One intriguing area of interest is “culture”-defined as the prevailing values, attitudes, beliefs, and underlying assumptions about life held by concept of wealth that emphasizes majority or minority groups in a society. There is a link between cultural values and human progress.  Scholars are beginning to explore how political and social action can make cultures more favourable to progress.

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Gunnar Myrdal thought that South and Southeast Asians are soft societies with low expectations. He said that they are lazy and do not demand much. As a result, they do not grow. However, the rise of Japan, the emergence of China as an industrial giant, and the Newly Industrializing Countries (South Korea, Singapore, Taiwain and Hong Kong) as well as ASEAN proved his foresight was limited.

Two basic ideological concerns crop up:

(1) Are some cultures truly “better” than others?  That is, do certain sets of beliefs and practices offer distinct advantages in dealing with life’s challenges?

(2) If existing cultures can be changed to promote progress, who should be changing, and how?

Some cultural attitudes or mind-sets that appear to help promote progress:

1. Time Orientation: Progressive cultures emphasize the near future, while static cultures focus on the past or the far future.

2. Work is valued for its own sake in progressive cultures, but viewed as a burden in static cultures.

3. Frugality is respected as prudent in progressive cultures, but viewed with suspicion as selfishness in static cultures.

4. Education is ideally offered to all in progressive cultures; it is the exclusive privilege of the elite in static cultures.

5. Merit is considered the only proper basis for advancement in progressive cultures, while family and connections matter more in static cultures.

6. Community is more broadly defined in progressive cultures, which tends to trust and identify with many groups; in static cultures; individuals feel closely bound only to their own family or nearest neighbors.

7. Ethical Codes are more rigorous in progressive cultures, which tend to be less corrupt than static cultures-though there are notable exceptions.

8. Justice and fair-play are held as universal ideals in progressive societies, but more cynically perceived in static cultures as dependent on wealth and influence.

9. Authority tends to be more widely dispersed in progressive cultures; it is more concentrated and exercised from above in static cultures.

10. Religion’s influence on civic life tends to be small in progressive cultures; in static cultures, religious institutions often exercise substantial influence in public affairs.

These traits may not be universally beneficial, since changing world conditions can turn advantages into liabilities and vice-versa. Certainly cultural traits change over time. And efforts to include ethics and values training in the public schools demonstrate the widespread belief that such changes can be brought about through direct action. But critics of cultural interference have a point, too. It is unlikely that Western standards of utility and moral behavior can be imposed from outside to change a nation or a group’s beliefs. Even military action seems to have had little impact on the aims and values of citizens or their leaders in “rogue” nations. Lasting changes arise from within a culture; to achieve progress the value of these changes must be clear even to those who focus exclusively on local needs and interests, which may not necessarily be identical with global priorities and norms. Mariano Gronda, a writer and scholar from Argentina, identifies 20 specific factors that appear to make cultures more conducive to economic and social development. These include trust in the individual and a concept of wealth that emphasizes not what exists now, but what future potential may be realized from product of work and investment. Grondona notes that religion influence progress as well: Systems of belief that tend to praise or value poverty as a benefit to salvation and spiritual progress (Buddhism, Catholicism) may make economic development difficult “because the poor will feel justified in their poverty and the rich will be uncomfortable because they see themselves as sinners.” In contrast, cultures that treat poverty as a test to be endured or a condition to be overcome (Confucianism, Protestantism) encourage poor and rich alike to improve their condition and celebrate their success.

Cultural Barriers:

Traditions and habitual ways of doing business vary among societies, and not all are equally conducive to economic growth. In developing countries, cultural forces are often a source of inefficiency. Sometimes personal considerations of family, past favours, or traditional friendship or enmity are more important than market incentives in motivating behaviour. In a traditional society in which children are expected to stay in their parents’ occupations, it is more difficult for the labour force to change its characteristics and to adapt to the requirements of growth than in a society in which upward mobility is a goal itself. The fact that existing social, religious, or legal patterns may make growth more difficult does not imply that they are undesirable. Instead, it suggests that the benefits of these patterns must be weighed against the costs, of which the limitation on growth is one. When people derive satisfaction from a religion whose beliefs inhibit growth or when they value a society in which every household owns its own land and is more nearly self-sufficient than in another society, they may be quite willing to pay a price in terms of forgone growth opportunities. Many critics argue that development plans, particularly when imposed by economists coming from developed countries, pay too little attention to local cultural and religious values. Even when they are successful by the test of increasing GDP, such success may be at too great a cost in terms of social upheaval for the current generation. A country that wants development must accept some alteration in traditional ways of doing things. However, a trade-off between speed of development and amount of social upheaval can be made. The critics argue that such a trade-off should be made by local governments and should not be imposed by outsiders who understand little of local customs and beliefs. An even more unfavourable possibility is that the social upheaval will occur without achieving even the expected benefits of GDP growth. If the development policy does not take local values into account, the local population may not respond as predicted by Western economic theories. In this case, the results of the development effort may be disappointingly small.

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7. Lack of Incentives:

In the early stage of development, some inequality stimulates human desires to achieve a better life. Lack of private ownership did not contribute much to economic growth in the former Soviet Union. The rich or aristocrats provide a role model for the poor to reach higher income levels. Welfare programs destroy incentives for the poor to work. In the former Soviet Union, people were reluctant to work because pay was not linked to work.

Note:

Welfare programs destroy incentives for the poor to work; and people are reluctant to work because pay is not linked to work for everybody. India is a classic example of these two economic maladies. As a doctor working in government hospital catering poor people, my experience tells me that free medical treatment to poor people make them not work. Once poor people know that free medical treatment is available, there is no incentive to work as survival is ensured by free government hospital. Also, I know many government doctors who hardly work because they get monthly salary irrespective of their work. What I am telling is a tip of the iceberg and when these two maladies are multiplied in all segments of Indian society, you know why India cannot become developed nation.

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E. Natural disasters:

Natural disasters cause more damage in developing nations than developed nations.

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F.  Science and technology:

Science is the study of knowledge which can be made into a system and usually depends on seeing and testing facts and stating general laws. Technology on the other hand is the practical application of scientific knowledge or indentations to the solving of everyday problems or facilitating tedious human activities. For any successful economy, particularly in today’s quest for knowledge based economies, science, technology and engineering are the basic requisites. If nations do not implement science and technology, then the chances of getting themselves developed becomes minimal and thus could be even rated as an undeveloped nation. Science and Technology is associated in all means with modernity and it is an essential tool for rapid development. The product of science and technology has contributed to the development of countries such as America, Japan, China and to an extent in some developing countries. If carefully analysed, one gets to understand that countries which have a strong base in science and technology are the ones that developed faster. A few examples are of countries like Russia, Japan, Brazil, China, India and many more. It is really disheartening that many do not understand that the major difference between underdeveloped countries and developed nations is basically technological capability. This refers to how a country can access, create and utilize science and technology for solving socio-economic issues. The world is increasingly being driven by technological innovation. Medicine, education, agriculture, environment and energy, manufacturing and services, transportation, water and clean air are all based ultimately on science and technology. Hence, it is apparent that to become successful in this modern world, technology elements must be incorporated into the improvement process. Developments in science and technology are fundamentally altering the way people live, connect, communicate and transact, with profound effects on economic development. To promote tech advance, developing countries should invest in quality education for youth, and continuous skills training for workers and managers. The adoption of technology by developing countries has had profound effects on their economies, such as reducing the national costs of production, establishing standards for quality, and allowing individuals to communication from a distance. Unfortunately, the current process remains one of adaptation, rather than innovation. In addition, the need for technologies appropriate to the capabilities of a developing country’s poor has only recently been recognized. One major challenge to the diffusion of technology in low-income nations that persists is its uneven distribution and penetration within the country. The rapid spread of technology fuelled by the Internet has led to positive cultural changes in developing countries. Easier, faster communication has contributed to the rise of democracy, as well as the alleviation of poverty. Globalization can also increase cultural awareness and promote diversity. However, the diffusion of technology must be carefully controlled to prevent negative cultural consequences. Developing countries risk losing their cultural identities and assimilating themselves into an increasingly westernized world.

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What common factors are associated with successful development?

Experts who have experience in development policy, investment, and finance noted several common factors associated with overall progress in development:

1. Economic Growth:

Countries that have reduced poverty substantially and in sustained manner are those that have grown the fastest. Successful development requires sustained periods of high per capita income growth.

2. Vibrant Private Sector:

Private firms, including small and medium-sized businesses in rural nonfarm areas, play a critical role in generating employment, particularly for youth and poor people.

3. Empowerment:

All people should have the ability to invest in their health and education and to shape their own lives by being able to participate in the opportunities provided by economic growth and have their voices heard about decisions that affect their lives. Access to essential public services, such as health, education, and safe water is critical and should be provided equitably.

4. Good Governance:

An active state with good governance in both the public and private sectors fosters an environment where contracts are enforced and markets can operate efficiently. It also ensures that basic infrastructure functions, adequate health and education services, and social protections exist, and people can participate in decisions that affect their lives.

5. Ownership:

Countries need to own their development agenda. This helps ensure that there is widespread support for development programs and the reform measures that underpin them.

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Development Model postulated by Rostow:

Developing country —generally referring to the countries of Africa, Asia, and Latin America—is a term that was inspired by Walt Whitman Rostow’s classic work, The Stages of Economic Growth: A Non-Communist Manifesto (1960). Rostow argued that all countries go through a series of stages of economic development from “underdeveloped” to “developed”; that the United States, Western Europe, and Japan had reached the “highest stage” or “developed-country” status; and that those countries that were not mature, developed capitalist countries were in the process of “developing” and moving through the required stages. According to Rostow, third World countries are in transition from traditional lifestyles towards the modern lifestyle which began in the Industrial Revolution in the 18th and 19th centuries.

Rostow’s Five Stages of Growth:

1. Pre-development: the traditional society is highly active in agriculture and “non-productive” activities such as military.

2. The preconditions for take-off: new investments in technology and infrastructure to increase productivity.

3. The take-off: the nation grows fast economically through certain industries.

4. The drive to maturity: more and more industries “take-off”, growing and specializing.

5. The age of mass consumption: shifting from heavy industry to consumer goods.

Examples: South Korea, Singapore, Taiwan, and Hong Kong: the “four dragons”. Lacking natural resources, they produced specific manufactured goods (clothing and electronics) which turned out to be inexpensive (low labor costs) for developed nations and the developing nations grew.

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How did developed countries develop?

IMF recently provided a list of following ten countries as developed nations:

United States, France, Germany, Australia, Canada, Italy, Japan, South Korea, Spain and the United Kingdom. This is not in any order.

•The countries have had significant advantage in terms of the time when they began to grow their economic development and have been doing so more or less continuously. Many of them except South Korea started latest by 19th century. UK, USA, Germany, France have developed even in 17th and 18th centuries.

•For UK, France, Spain colonizing helped them to grow economically.

•Although Australia and Canada have been dominions of British Empire, they were allowed considerable freedom by UK to grow their economies.

•Most of the countries participated and were devastated by WW I and WW II. But they were well developed even before (except South Korea)

•Although they have been impacted by war, they continued in economic development afterwards.

•In the case of South Korea, it was quite an impoverished nation till they were helped by USA. But USA invested a lot on South Korea and they also followed similar economic policies of USA. With aid and free market policy, they were able to grow economically.

•All these countries are post-industrial economies with service sector contributing to a great share of their economy.

•The Human Development Index in these countries are very high.

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The figure below shows roadmap to economic development of a nation:

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Convergence and divergence in development:

Many times there is a clear distinction between First and Third Worlds. When talking about the Global North and the Global South, the majority of the times the two go hand in hand. People refer to the two as “Third World/South” and “First World/North” because the Global North is more affluent and developed, whereas the Global South is less developed and often poorer. To counter this mode of thought, some scholars began proposing the idea of a change in world dynamics that began in the late 1980s, and termed it the Great Convergence. As Jack A. Goldstone and his colleagues put it, “in the twentieth century, the Great Divergence peaked before the First World War and continued until the early 1970s, then, after two decades of indeterminate fluctuations, in the late 1980s it was replaced by the Great Convergence as the majority of Third World countries reached economic growth rates significantly higher than those in most First World countries”. So divergence means economic growth rate of rich nations higher than poor nations, convergence means economic growth rate of poor nations higher than rich nations.  One puzzle of the world economy is that for 200 years, the world’s rich countries grew faster than poorer countries, a process aptly described by Lant Pritchett as “Divergence, Big Time.” When Adam Smith wrote The Wealth of Nations in 1776, per capita income in the world’s richest country – probably the Netherlands – was about four times that of the poorest countries. Two centuries later, the Netherlands was 40 times richer than China, 24 times richer than India, and ten times richer than Thailand. But, over the past three decades, the trend reversed. Now, the Netherlands is only 11 times richer than India and barely four times richer than China and Thailand. Spotting this reversal, the Nobel laureate economist Michael Spence has argued that the world is poised for The Next Convergence. Yet some countries are still diverging. While the Netherlands was 5.8, 7.7, and 15 times richer than Nicaragua, Côte D’Ivoire, and Kenya, respectively, in 1980, by 2012 it was 10.5, 21.1, and 24.4 times richer. What could explain generalized divergence in one period and selective convergence in another? Why didn’t they grow faster for so long, and why are they doing so now? Why are some countries now converging, while others continue to diverge? There are potentially many answers to these questions. The economic expansion of the last two centuries has been based on an explosion of knowledge about what can be made, and how. Goods and services are made by stringing together productive capabilities – inputs, technologies, and tasks. Countries that have a greater variety of capabilities can make more diverse and complex goods. Learning to master new technologies and tasks lies at the heart of the growth process. If, while learning, you face competition from those with experience, you will never live long enough to acquire the experience yourself. This has been the basic argument behind import-substitution strategies, which use trade barriers as their main policy instrument. The problem with trade protection is that restricting foreign competition also means preventing access to inputs and knowhow. Participating in global value chains is an alternative way to learn by doing that is potentially more powerful than closing markets to foreign competition. It enables a parsimonious accumulation of productive capabilities by reducing the number of capabilities that need to be in place in order to get into business. This strategy requires a highly open trade policy, because it requires sending goods across borders many times. But this does not imply laissez-faire; on the contrary, it requires activist policies in many areas, such as education and training, infrastructure, R&D, business promotion and the development of links to the global economy.

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Gap between developed and developing nations:

Now let me discuss the disparity between developed and developing nations:

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The figure below depicts basic differences between developed and developing nation:

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Difference in poverty:

Poverty in India means per capita daily income less than Rs 32 (half dollar) in rural area and Rs 47 (three quarter dollar) in urban area. World Bank poverty line is per capita income less than $ 1.25 per day. In the U.S. poverty line in 2010 for a family of 4 with no children under 18 years of age is $22,541 per year. It comes to 15$ per capita per day. So you cannot compare Indian poverty with American poverty. Despite the poverty line being higher in developed nations compared to developing nations, small segment of population live below poverty line in developed nations while very large segment of population live below poverty line in developing nations.

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Difference between Ecological Footprint:

The ecological footprint is a measure of human demand on the Earth’s ecosystems, the amount of natural capital used each year. The footprint of a region can be contrasted with the natural resources it generates. The world-average ecological footprint in 2007 was 2.7 global hectares per person (18.0 billion in total). With world-average biocapacity of 1.8 global hectares per person (12 billion in total), this leads to an ecological deficit of 0.9 global hectares per person (6 billion in total). There is no country in the world that has achieved high human development index within the limits of Earth’s ecosystem. What we need is high human development using low ecological foot print per capita. If everyone in the world lived like an average American, a total of four Earths would be required to regenerate humanity’s annual demand on nature. What we need is high level of human development without exerting unsustainable pressure on the planet’s ecological resources.

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Ecological footprint worldwide:

The figure above shows more developed countries generally have a higher ecological footprint than poorer, less developed countries. The rapid economic expansion of Brazil, Russia, India, Indonesia, China and South Africa – the so-called BRIICS group – merits special attention when looking at the Ecological Footprint and the pressure on biocapacity. High population growth in the BRIICS group along with increasing average consumption per person is contributing to an economic transformation. As a result, the BRIICS economies are expanding more rapidly than those of high-income countries. This growth will bring important social benefits to these countries. The challenge, however, is to do this sustainably.

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The Digital Divide:

During the heyday of the dotcom bubble, the notion arose of a digital divide, the disparity between the widespread internet access in industrialized nations vs. the limited connectivity in developing ones. Development could be accelerated, so the theory went, if internet access became available to the nations with the fewest resources. However, the fallacy with this notion is that it defines the digital divide as the cause of underdevelopment, rather than as a symptom. Healthcare, food, and personal safety are more pressing needs. Notwithstanding, the UN and various non-profit agencies have attempted to open regional computer centers and build internet infrastructures in developing nations, but these efforts have added few new users to the systems. Even Microsoft Chairman, Bill Gates, one of the world’s most generous philanthropists, has focused upon health, rather than technology, in developing nations.

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Global Mobile Phone Usage, 2011

Region Mobile Phone Subscriptions per 100 Inhabitants
Africa 53
Asia & Pacific 74
Americas 103
Europe 120
Source International Telecommunication Union (2011)

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Nearly All Future Population Growth will be in the World’s Less Developed Countries:

World population grew to 7.06 billion in mid-2012 after having passed the 7 billion mark in 2011. Developing countries accounted for 97 percent of this growth because of the dual effects of high birth rates and young populations. Conversely, in the developed countries the annual number of births barely exceeds deaths because of low birth rates and much older populations. By 2025, it is likely that deaths will exceed births in the developed countries, the first time this will have happened in history.  While virtually all future population growth will be in developing countries, the poorest of these countries will see the greatest percentage increase. As defined by the United Nations, these 48 countries have especially low incomes, high economic vulnerability, and poor human development indicators such as low life expectancy at birth, very low per capita income, and low levels of education. Of these countries, 33 are in sub-Saharan Africa, such as Burundi, Ethiopia, Mozambique, and Zambia; 14 in Asia, including Bangladesh, Cambodia, Nepal, and Yemen; and one in the Caribbean, Haiti. They are growing at 2.4 percent per year and are projected to reach at least 2 billion by 2050.

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The Demographic Divide:

The radically different demographic situation between developed and developing countries illustrates the “demographic divide”: the vast gulf in birth and death rates among the world’s countries. On one side of this divide are mostly poor countries with relatively high birth rates and low life expectancies. On the other side are mostly wealthy countries with birth rates so low that population decline is all but guaranteed and where average life expectancy extends past age 75, creating rapidly aging populations. The table shows just how wide these gaps have become.

Tanzania Spain
Population (2012) 48 million 46 million
Projected Population (2050) 138 million 48 million
Lifetime Births per Woman (TFR) 5.4 1.4
Annual Births 1.9 million 483,000
Percent of Population Below Age 15 45% 15%
Percent of Population Ages 65+ 3% 17%
Percent of Population Ages 65+ (2050) 4% 33%
Life Expectancy at Birth 57 years 82 years
Infant Mortality Rate (per 1,000 live births) 51 3.2
Annual Number of Infant Deaths 98,000 1,600
Percent of Adults Ages 15-49 With HIV/AIDS 5.6% 0.4%

Even though Tanzania and Spain have almost the same population size today, Tanzania is projected to more than double its population from 48 million to 138 million in 2050. Spain’s population will only slightly increase, from 46 million today to 48 million by 2050. The cause of this enormous difference is lifetime births per woman. Tanzania’s total fertility rate of 5.4 children per woman is almost four times greater than Spain’s rate of 1.4.

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Age Structure:

Although the most commonly discussed characteristics of a population have to do with births and deaths, there is another important characteristic that combines these statistics. This characteristic is the population’s age structure, which is the distribution of the population based on age categories. The age structure of a population is often displayed using age-sex pyramids as seen in the figure below, which graphically represent how the population is distributed by both age and sex. The pyramid is comprised of many horizontal bars representing the size of the population at each age category, with young categories at the bottom of the pyramid and old at the top.

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Due to the variation in infant mortality and fertility rates between developed and developing countries, the age structure is always quite different. In developed countries, the population is distributed relatively evenly over all age categories. This results in a median age in the late thirties and an age-sex pyramid with very straight sides due to the evenly sized horizontal bars.

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Real Economic Growth: Developed vs. Emerging & Developing Nations:

Investment: Developed vs. Developing Countries:

Over the last 20 years, a major shift in the origin of the World investment has occurred. Developed economies used to produce in their economies about 80% of the World investment (measured in current prices), against approximately 20% of the Emerging and Developing Economies. Today these two set of countries are investing about the same amount of money. Therefore, over the last 20 years, developed nations moved from a position where they were investing four times as much as the rest of the world towards a position where they currently invest approximately the same amount.

Savings: Developed vs. Developing Countries:

One might ask if this increase has been done via saving transfers from developed to developing nations but the reality shows us that, in general, the increase in investment in Emerging and Developing economies has been financed with savings generated among these set of countries. In fact, most of the world gross savings are already been produced in Emerging and Developing nations. This big shift in the World investment distribution might help us understand why we have experienced a shift in the world economic growth from the so called “first world” towards the “third world” but also why we might be experiencing an increase trend of the world economic growth while investment, in percentage of the GDP, appears to have diminished slightly.

Growth: Developed vs. Developing Countries:

For this assumption to hold, though, one should expect a higher ratio of growth/capital in developing nations to exist.  Is this actually the case? Analyzing historical data from the IMF allows as to see that by 2007, before the last world crises began, emerging and developing countries were already responsible for about 2/3 of all the World real economic growth (twice as much as the growth generated by the so called Developed world) and they were doing so with just 34.6% of the World volume of investment. This finding is relevant because it indicates that the Emerging and Developing countries, right before our most recent world economic crises, were being able to grow much faster than developed economies for the each dollar they invested in their economy. This becomes even more relevant when we acknowledge that they are already producing most of the world savings.

With such high saving, developing nations could afford to maintain high investment growth rates during the latest economic crises. In fact, recent stimulus packages to promote growth in China and other developing economies, looking forward to sustain growth while World exports were plummeting during the 2008/2009 crises, might help to explain part of the most recent jump in the World investment quota that less developed experienced. Also, this increase might contribute to a lower gap between the productivity of investment in Developed nations and the rest of the world. In fact, some evidence can be found that this might be happening since 2008 even though Emerging and Developing nations continue to register on average roughly twice as much real economic growth as the one registered by developed economies per each nominal dollar of gross investment.

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Growth of developing countries:

The table below shows the annual percentage change of global output by region, showing that developing countries tend to demonstrate higher growth rates than the developed ones.

Region 2007 2008 2009 2010
World Output 5.4 2.9 -0.5 5.0
Advanced Economies 2.7 0.2 -3.4 3.0
Emerging and Developing Economies 8.8 6.1 2.7 7.3
Least Developed Countries 9.0 6.9 5.2 5

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The figure below shows world map of economic growth. Developing countries like India and China are growing much faster than developed nation. This is because developed nations are in post-industrial service sector economy while developing nations are in the process of industrialization.

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Widening gap:

The figure below shows that although economic growth occurred in developing nations in last 50 years, the gap between developed and developing nations has widened. This is because although some developing nations are growing faster than developed nations, their population explosion reduces GDP per capita substantially compared to developed nations.

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The uneven pattern of Development: income inequality:

Data on per capita incomes throughout the world as shown in the table below cannot be accurate down to the last $100 because there are many problems in comparing national incomes across countries. For example, home-grown food is vitally important to living standards in developing countries, but it is excluded from or at best imperfectly included in the national income statistics of most countries. Nevertheless, the data reflect enormous real differences in living standards that no statistical inaccuracies can hide. The development gap—the discrepancy between the standards of living in countries at either ends of the distribution—is real and large. 1% of the world’s population has come to accumulate half of the world’s total wealth, and the richest 300 individuals lay claim to more than the poorest 3 billion.

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In 2014, Credit Suisse researchers estimate, individuals holding over $1 million in wealth — the richest 0.7 percent of adults globally — held 44 percent of global net worth. Is the world, as a whole, growing more or less unequal? This simple question has no simple answer. Branko Milanovic, a senior scholar with the Luxembourg Income Survey now at the City University of New York’s Graduate Center, has done the world’s most rigorous research on the global income inequality picture. His latest research, published in December 2014, carries the theme “national vices, global virtue.” Inequality within nations is increasing, Milanovic notes, but inequality worldwide seems to be slightly decreasing as middle classes emerge in China and India and the incomes of typical families in the United States and other rich countries stagnate and even, after inflation, decrease. But this slight worldwide decrease in overall inequality, Milanovich cautions, may be somewhat illusory since available national data regularly underestimate top 1 percent incomes and global tax havens conceal still more income at the economic summit.

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The gap between rich and poor keeps widening. Growth, if any, has disproportionally benefited higher income groups while lower income households have been left behind. This long-run increase in income inequality not only raises social and political concerns, but also economic ones. It tends to drag down GDP growth, due to the rising distance of the lower 40% from the rest of society. Lower income people have been prevented from realising their human capital potential, which is bad for the economy as a whole. The econometric analysis suggests that income inequality has a sizeable and statistically significant negative impact on growth. The new OECD report finds that between 1990 and 2010 gross domestic product per person in 19 core OECD countries grew by a total of 28 percent, but would have grown by 33 percent over the same period if inequality had not increased after 1985. This estimate is based on an econometric analysis of 31 high- and middle-income OECD countries, which concluded that lowering inequality by just one “Gini-point” (a standard measure of inequality used by economists) would raise the annual growth rate of GDP by 0.15 percentage points.

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Affluent citizens in Japan and in the West are also likely to worry about income inequality. A widening gap between the wealthy and the rest of society may foster growth by encouraging many people to work hard, but in the long term, high levels of inequality could well undermine popular support for democracy. Can a country with very unequal incomes have political freedom for long? The United Kingdom and the United States, two of the industrial countries near the top of the freedom index, seem bent on testing the question.

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Interaction between developed and developing nations:

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Aid:

Rich countries don’t spend much on aid. The amount officially spent on each poor person globally is US$20 a year, according to the World Bank. The amount has doubled in the last decade following a dip in the late 1990s. But several opinion polls show that rich country inhabitants think they’re much more generous than they really are. Americans think that their government spends 28% of the budget on aid when it’s really about 1%. Brits are almost as bad. The result of this widespread overestimation of generosity is that many people in rich countries want to cut aid. We need rich countries to transfer money to poor countries, to be sure, and in much greater quantities than they presently do. But these transfers should not be considered charity; they should be considered a form of justice. Franz Fanon puts it best: “Colonialism and imperialism have not settled their debt to us once they have withdrawn from our territories. The wealth of the imperialist nations is also our wealth. Europe is literally the creation of the Third World. The riches which are choking it are those plundered from the underdeveloped peoples. So we will not accept aid for the underdeveloped countries as ‘charity’. Such aid must be considered the final stage of a dual consciousness – the consciousness of the colonised that it is their due, and the consciousness of the capitalist powers that effectively they must pay up.”

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Aid works:

Both developmental and humanitarian aids do work. It’s not widely known that development aid was instrumental in supporting the growth of Singapore, one of the world’s most remarkable economic success stories. The United Nations Development Programme contributed 744 technical assistants from 1950 onwards and spent US$27 million on development help. In 1960 a visiting UNDP team led by Dutchman Dr Albert Winsemius, who became a trusted adviser to Lee Kuan Yew until the 1980s, wrote a report entitled “A proposed industrialisation programme for the State of Singapore”. This document formed the basis of early development strategy. Other major aid recipients that now receive very little include Botswana, Morocco, Brazil, Mexico, Chile, Costa Rica, Peru, Thailand, Mauritius and Malaysia. Bill Gates reckons that through a combination of aid and spontaneous economic development there won’t be any very poor people left by 2035. He calculates that 100 million deaths have been avoided since the drop in child mortality since 1980, the start of the “Child Survival Revolution” that made vaccines and oral rehydration therapy much more widespread. Total aid, $500 billion, counts money for vaccines, HIV/AIDS, family planning, and water and sanitation from all donors. That works out at US$5000 per life saved, which he rightly says is quite cheap. Hundreds of millions of people have been immunized against Polio, treated for TB and given anti-retroviral treatment for HIV/AIDS.

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Foreign aid and development:

During the Cold War, unaligned countries of the Third World were seen as potential allies by both the First and Second World. Therefore, the United States and the Soviet Union went to great lengths to establish connections in these countries by offering economic and military support to gain strategically located alliances (e.g., United States in Vietnam or Soviet Union in Cuba). By the end of the Cold War, many Third World countries had adopted capitalist or communist economic models and continued to receive support from the side they had chosen. Throughout the Cold War and beyond, the countries of the Third World have been the priority recipients of Western foreign aid and the focus of economic development through mainstream theories such as modernization theory and dependency theory. By the end of the 1960s, the idea of the Third World came to represent countries in Africa, Asia and Latin America that were considered underdeveloped by the West based on a variety of characteristics (low economic development, low life expectancy, high rates of poverty and disease, etc.). These countries became the targets for aid and support from governments, NGOs and individuals from wealthier nations. One popular model discussed earlier, known as Rostow’s stages of growth, argued that development took place in 5 stages (Traditional Society; Pre-conditions for Take-off; Take-off; Drive to Maturity; Age of High Mass Consumption). W. W. Rostow argued that Take-off was the critical stage that the Third World was missing or struggling with. Thus, foreign aid was needed to help kick-start industrialization and economic growth in these countries. However, despite decades of receiving aid and experiencing different development models (which have had very little success), many Third World countries’ economies are still dependent on developed countries, and are deep in debt. There is now a growing debate about why Third World countries remain impoverished and underdeveloped after all this time. Many argue that current methods of aid are not working and are calling for reducing foreign aid (and therefore dependency) and utilizing different economic theories than the traditional mainstream theories from the West. Historically, development and aid have not accomplished the goals they were meant to, and currently the global gap between the rich and poor is greater than ever, though not everybody agrees with this.

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Economic freedom vs. aid:

A few decades ago, policymakers in Washington and other Western capitals believed that they could hasten economic progress in poor countries with extensive aid and investment programs. They encouraged private companies to invest as well, but they believed that only governments could assemble enough capital to jump-start disadvantaged economies. Much of the money that was poured into those countries, however, went into grandiose but unproductive projects, propping up over-valued currencies and enriching corrupt officials. After dismal failures in Latin America, Africa, and southern Asia, the political will in much of the West has moved increasingly to the opposite strategy of letting poor countries fix themselves. More and more analysts now say that economic freedom is the main driver of economic development. Executives looking for growth opportunities abroad, they argue, should ask the same questions about the investment climate that they ask in more familiar settings: How high are the taxes? What regulations and licenses will we have to worry about? How easy is it to send goods and profits back and forth? For the past three years, the Heritage Foundation has made these and other calculations easier with its Index of Economic Freedom, an annual assessment of almost all the countries of the world. The Index of Economic Freedom is based on a composite of ten crude, mostly quantitative indicators: tariff rates, taxation, government’s share of output, inflation (a proxy for monetary policy), limits on foreign investment, banking restrictions, wage and price controls, property rights, general business regulation, and the extent of the black market. The Wall Street Journal joined the effort this year, making an expanded edition possible and ensuring broader readership. The new edition, which compiles reports from several authors, claims more confidently than ever that the prosperous countries of the world got that way—and are getting more so—by letting markets do the work. The editors write that “although there are many theories about the origins and causes of economic development, the findings of this study are conclusive: Those countries with the most economic freedom have higher rates of economic development than those with less economic freedom.” Undoubtedly, economic growth does depend on a degree of economic freedom, and under some circumstances, more freedom will promote additional growth. But the paths to growth that countries take are much more complicated than the Index indicates. In the case of newly prospering countries, the Index confuses cause and effect: freedom is more often the result than the cause of development. With regard to countries already rich, the book starts from a faulty assumption that growth is all that their citizens should care about. The Index is hardly a straightforward report of scientific research.

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Cash transfer as aid:

More aid should be in the form grants rather than loans. Cash transfers are the best way of delivering some help. For example the British Department for International Development works with Unicef and the Kenyan Government in Korogocho, Nairobi, to improve the lives of orphans and vulnerable children through a cash transfer scheme which gives very poor families 3000 Kenyan shillings (about £25) every two months for help with basic household expenses. It cuts out the middleman and it’s been proven through robust testing to reduce poverty, hunger and inequality.

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Donor Dependencies:

Developing countries receive a substantial amount of foreign aid. But this aid is not always given with good intention. Foreign countries that donate money do so in order to influence the developing country in their interest. Foreign countries use the dependency on donor aid in several ways. One standard method is “tied aid”, i.e., money that is given under the condition that it be spent on products from the donor country. Another one is an indirect political pressure on the developing country to make political decisions in the interest of the donor country. Finally, the money is not always donated in a way that supports sustainable progress in the recipient country. It is often donated to causes that harm the environment, to military equipment, or to counter-effective subsidies. By influencing the developing country, the donor country advances its own interests, and disregards the interests of the recipient country. If, e.g., all aid money has to be spent on products or services from the donor country, then the recipient country can suffocate its own local competitors. As Thomas Sankara remarked, “he who feeds you, controls you”.

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How Poor Countries Develop Rich Countries:

The problem with the dominant narrative about aid is that it casts Western countries in the role of benevolent benefactors, giving generously of their wealth to poor countries in the Global South. In reality, however, exactly the opposite is true. The flow of aid from rich countries to poor countries pales in comparison to the flow of wealth that runs the other direction. Developing countries receive about $136 billion in aid from donor countries each year. At the same time, however, they lose about $1 trillion each year through offshore capital flight, mostly in the form of tax avoidance by multinational corporations. That’s nearly 10 times the size of the aid budget. Because rich countries include debt cancellation as aid, it is only fair that we include debt service payments as part of the equation as well. Today, poor countries pay about $600 billion to rich countries in debt service each year, much of it on the compound interest of loans accumulated by rulers long since deposed. This alone amounts to nearly 5 times the aid budget. Using this metric, economist Charles Abugre calculates that the net flow of aid from the West to the Global South over the period 2002 to 2007 was minus $2.8 trillion. And that does not include the capital flight mentioned before. There are many other flows of wealth and income that are being siphoned from the Global South that we need to take into account. For example, Action Aid recently reported that multinational corporations extract about $138 billion from developing countries each year in tax holidays (which is different from tax avoidance). This figure alone outstrips the global aid budget. For another example, we can look at the WTO’s agreement on intellectual property rights (TRIPS), which has armed corporations with unprecedented rent-seeking powers. As a result of TRIPS, developing countries have been forced to pay $60 billion annually – half the aid budget – in extra patent licensing fees, over and above those required by normal laws, for the use of technologies and pharmaceuticals that are often essential to development and public health. We can see these figures as direct cash transfers from poor countries to rich countries. And this is to say nothing of other forms of extraction that are more difficult to quantify, such as land grabs. Fred Pearce shows that land exceeding the size of Western Europe has been grabbed from developing countries by corporations in the past decade alone. The US, UK, and China are leading this movement by snapping up agricultural land in regions where land tenure laws leave indigenous inhabitants vulnerable to dispossession. The point is that aid does not exist in any meaningful sense. Poor countries are net creditors to rich countries. Aid serves as an illusion to mask this fact; it makes the takers seem like givers.

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Aid as a tool of extraction:

Beginning in the early 1980s, Western governments and financial institutions like the World Bank and IMF changed their development policy from one that was basically Keynesian to one that remains devotedly neoliberal, requiring radical market deregulation, fiscal austerity, and privatization in developing countries as a condition of receiving aid. We were told that this neoliberal shock therapy – known as structural adjustment – would help stimulate the economies of poor countries. But exactly the opposite happened. Instead of helping poor countries develop, structural adjustment basically destroyed them. Cambridge economist Ha-Joon Chang has demonstrated that while developing countries enjoyed per capita income growth of more than 3% prior to the 1980s, structural adjustment cut it in half, down to 1.7%. When it was foisted on Sub-Saharan Africa, per capita income began to decline at a rate of 0.7% per year, and average GNP shrank by around 10%. As a result, the number of Africans living in basic poverty nearly doubled. It would be hard to overstate the degree of human suffering that these figures represent. Robert Pollin, an economist at the University of Massachusetts, estimates that developing countries have lost roughly $480 billion in potential GDP as a result of structural adjustment. Yet Western corporations have benefitted tremendously. It has forced open vast new consumer markets; it has made it easier to access cheap labor and raw materials; it has opened up avenues for capital flight and tax avoidance; it has created a lucrative market in foreign debt; and it has facilitated a massive transfer of public resources into private hands (the World Bank alone has privatized more than $2 trillion worth of assets in developing countries). Poverty in the Global South is not just a static given; it is being actively created. And the striking thing is that these atrocities are being perpetrated under the cover of aid. In other words, not only does aid serve as a powerful rhetorical device that cloaks takers in the guise of givers, it also operates as a powerful tool in the global wealth extraction system.

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Trade:

Trade is the exchange of goods and services between countries. Few economists dispute that properly handled, trade is essential for development. We must not forget that if development is the objective, then trade is the tool with which to achieve it. Developed and developing countries have to work together to achieve this goal. The governments have to serve as a helping hand in facilitating trade and maximising the benefits of market forces. Promoting growth and development, improving the standards of living and tackling poverty have to be at the heart of using trade for development purposes.

• Goods, e.g. raw materials, food and manufactured products are called visible trade.

• Services, e.g. money spent by tourists, or foreign aid, are called invisible trade.

Many developing countries export primary products. These include things like oil, cotton, iron, bananas, coffee and cocoa. Developed countries export a greater number and range of secondary products. These are often manufactured goods which are made from primary products from developing countries. Over 50% of trade takes place between developed countries, for example, the trading of cars to provide everybody with a greater choice. Less trading happens between developing countries as most of them produce the same products. Rich countries in North America, especially the USA, and countries in free trade areas, such as the EU, dominate world trade.

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Trade between developed and developing countries:

Difficult problems frequently arise out of trade between developed and developing countries. Most less-developed countries have agriculture-based economies, and many are tropical, causing them to rely heavily upon the proceeds from export of one or two crops, such as coffee, cacao, or sugar. Markets for such goods are highly competitive (in the sense in which economists use the term competitive)—that is, prices are extremely sensitive to every change in demand or in supply. Conversely, the prices of manufactured goods, the typical exports of developed countries, are commonly much more stable. Hence, as the price of its export commodity fluctuates, the tropical country experiences large fluctuations in its “terms of trade,” the ratio of export prices to import prices, often with painful effects on the domestic economy. With respect to almost all important primary commodities, efforts have been made at price stabilization and output control. These efforts have met with varied success. Trade between developed and less-developed countries has been the subject of great controversy. Critics cite exploitation of foreign labour and of the environment and the abandonment of native labour needs as multinational corporations from developed countries transport business to countries with cheaper labour pools and relatively little economic or political clout. Especially after 1999, when trade talks were disrupted by globalization protesters during the WTO ministerial conference in Seattle, the work of the WTO came under increasing scrutiny from its critics. These critics voiced a number of concerns about the power and scope of the WTO, with the gravest criticisms clustering around issues such as environmental impact, health and safety, the rights of domestic workers, the democratic nature of the WTO, national sovereignty, and the long-term wisdom of endorsing commercialism and free trade to the neglect of other values.

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Trade Regulations:

Trade between rich and poor countries is regulated through international treaties. However these treaties give a disadvantage to the poor countries. The Roca-Runciman Treaty, e.g., was a trade agreement between Argentina and the British Empire that severely disadvantaged Argentina. As Roca summarized, it made Argentina “an integral economic part of the British Empire”. Other influence happens through international organizations: the World Trade Organization (WTO), the World Bank, and the International Monetary Fund (IMF). The WTO, in particular, has been criticized for representing mainly the interests of the rich countries. The main asymmetry is as follows:

1. Rich countries subsidize their agriculture. This means that their agricultural exports are cheap. This means that consumers (in rich and poor countries alike) buy rich countries’ products. These give a disadvantage to the poor countries, where a large part of the population depends on agriculture.

2. Rich countries want to tear down customs and trade restrictions to poor countries. This allows the rich countries to export into the poor countries. The poor countries do not yet have the economic infrastructure to compete with the rich countries’ products. Hence, people buy the rich countries’ products, and the industry of the poor country cannot develop.

3. At the same time, rich countries do their best to protect their own market from the products from poor countries. This makes it difficult for poor countries to export to the rich ones.

4. Finally, rich countries insist on protecting their patents, which leads to high prices for technology and medicine for poor countries.

Net result:

If rich countries force open the markets of poor countries, but subsidize their own agriculture at the same time, then the markets of poor countries are flooded with cheap food. This may help reduce hunger in the poor countries on the short run, but ultimately takes away the main economic activity of large parts of the population. This pushes these people into poverty — and ultimately increases hunger and misery. As Global Exchange, an activist group, summarizes, “WTO policies have allowed dumping of heavily subsidized industrially produced food into poor countries, undermining local production and increasing hunger”. The Economist further argues that trade obstacles for export from poor countries to rich countries severely hamper progress in the developing nations.

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Aid for Trade:

The debate over whether developing countries need aid or trade is at an end. Today, there is widespread recognition that developing countries need both. But WTO agreements do not guarantee increased trade flows: they provide opportunities. Some countries are better placed than others to grasp those opportunities. Some need help: “Aid for Trade” and various other tools are aimed at enhancing the capacity of developing countries to participate more effectively in the global marketplace.  Donor countries have committed an average of $40 billion a year to trade-related development programmes while recipient countries have had success in pinpointing the specific areas where aid is needed and in mainstreaming trade into their development strategies.

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Globalization:

The Impact of Globalization in the Developing Countries:

Globalization is a process of global economic, political and cultural integration. It has made the world become a small village; the borders have been broken down between countries. ”The history of globalization goes back to the second half of the twentieth century, the development of transport and communication technology led to situation where national borders appeared to be too limiting for economic activity”. Globalization is playing an increasingly important role in the developing countries. It can be seen that, globalization has certain advantages such as economic processes, technological developments, political influences, health systems, social and natural environment factors. It has a lot of benefit on our daily life. Globalization has created a new opportunities for developing countries. Such as, technology transfer hold out promise, greater opportunities to access developed countries markets, growth and improved productivity and living standards. However, it is not true that all effects of this phenomenon are positive. Because, globalization has also brought up new challenges such as, environmental deteriorations, instability in commercial and financial markets, increase inequity across and within nations. Developing countries such as India, China, Africa, Iraq, Syria, Lebanon and Jordan have been affected by globalization, and whether negatively or positively, the economies of these countries have improved under the influence of globalization. The size of direct foreign investment has increased and a lot of bad habits and traditions erased, but also globalization has brought many drawbacks to these countries as well. Many customs and cultures are disappeared such as traditions clothes and some language and expressions have changed. In addition, the violence and drugs abuse are increased and a lot of deadly diseases have spread under the influence of globalization. However, although globalization has many disadvantages, globalization has brought the developing countries many more benefits than the detriments. For example, we can see there is more and a biggest opportunity for people in both developed countries and developing countries to sell as many goods to as many people as right now, so we can say this is the golden age for business, commerce and trade.

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Brain drain:

The term “brain drain” designates the international transfer of resources in the form of human capital i.e., the migration of relatively highly educated individuals from the developing to developed countries. This phenomenon, in the terminology of development economics refers to the loss of high quality manpower, which was once productively employed in the native country. The last decade has seen an increase in the international mobility of highly skilled, talented individuals in response to the expansion of the knowledge economy accompanying globalization. This international movement of human capital can be identified, in practice, as the movement of scientists, doctors, educationists, engineers, executives, and other professionals across frontiers. These are people with special talents, high skills and specialized knowledge. The irony of international migration today is that many people who migrate legally from poor to richer lands are the ones that the Third World Countries can least afford to lose: the highly educated and skilled. Since the great majority of these migrants move on a permanent basis, this perverse brain drain not only represents loss of valuable human resources but could prove to be a serious constraint on the future economic progress of Third World nations. The number of international migrants increased from 75 million in 1960 to 190 million in 2005, at about the same pace as the world population, meaning that the world migration rate increased only slightly, from 2.5 to 2.9 percent. Over the same period, the world trade/GDP ratio increased threefold, rising from 0.1 to 0.2 between 1960 and 1990 and from 0.2 to 0.3 between 1990 and 2000; the ratio of FDI to world output, on the other hand, increased threefold during the 1990s alone. From these figures one might conclude that globalization is mainly about trade and FDI, not migration. However, the picture changes once the focus is narrowed to migration to developed countries and in particular its skilled component. The share of the foreign-born in the population of high-income countries has tripled since 1960 (and doubled since 1985). Moreover, these immigrants are increasingly skilled: while migration to the OECD area increased at the same rate as trade, high-skill migration (or brain drain) from developing to developed countries rose at a much faster pace and can certainly be regarded as one of the major aspects of globalization.

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Brain drain is the migration of skilled human resources for trade, education, etc. Trained health professionals are needed in every part of the world. However, better standards of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in the developed countries attract talent from less developed areas. The majority of migration is from developing to developed countries. This is of growing concern worldwide because of its impact on the health systems in developing countries. These countries have invested in the education and training of young health professionals. This translates into a loss of considerable resources when these people migrate, with the direct benefit accruing to the recipient states who have not forked out the cost of educating them. The intellectuals of any country are some of the most expensive resources because of their training in terms of material cost and time, and most importantly, because of lost opportunity.  Employers in receiving countries take a different position; they have their own shortages of skilled people in specific fields and can drain a developing country of expertise by providing job opportunities.  Kupfer et al. provided the strategies to discourage migration to the USA, a major recipient country. However, keeping the social, political and economic conditions in the developing countries in mind, can we stop the brain drain? Probably not! The recent study on brain drain from 24 major countries published by the World Bank presented data on South Asian immigration to the USA as seen in the figure below.

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The recent literature shows that high-skill emigrations need not deplete a country’s human capital stock and can generate positive network externalities. The brain drain side of globalization creates winners and losers among developing countries, and certain source-country characteristics in terms of governance, technological distance, demographic size, and interactions between these, are associated with the ability of a country to capitalize on the incentives for human capital formation in a context of migration and seize the global benefits from having a skilled, educated diaspora. The case studies of the African medical brain drain, the exodus of European scientists to the United States, and the role of the Indian diaspora in the development of India’s IT sector, the conditions under which a country is gaining or losing are not a matter of fate; to a large extent, they depend on the public policies adopted in the receiving and sending countries.

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It has been estimated that foreign scientists from developing countries who are involved in research and development produce 4.5 tims more publications and 10 times more patents than their counterparts at home. Why is there such a vast difference in productive capacity? The context and conditions in which science and technology are able to prosper require political decisions, funding, infrastructure, technical support, and a scientific community; these are generally unavailable in developing countries. If developing countries provided world-class education and training opportunities, as well as opportunities for career advancement and employment, the migratory flow could be reduced. However, in reality, this may not make much difference. On the plus side, foreign-born graduates acquire expensive skills which are not available within their countries. On the negative side, these skills and knowledge never migrate back to their own countries. Remittances from expatriates living abroad constitute a significant proportion of foreign revenue for many developing countries.  In Bangladesh for example US$ 2 billion is received from citizens who have emigrated overseas, and these remittances are the second largest source of foreign revenue. The transfer and management of remittance revenues are potentially exploitable factors in plumbing the brain drain. Formalizing the transfer of remittances might permit the generation of revenues that could be invested nationally in the social and economic development of the developing home country. However, the magnitude and economic importance of remittances, economic development and growth, and ultimately social equity, depend on the endogenous capacity of each nation’s human resources. If only a small percentage of the multimillion dollar sums sent home by emigrants could be invested in research and development, might not opportunities for highly skilled and educated nationals improve at home? And would this not in turn spur economic development? Maybe to some extent—but without resources and skills, this may not have a huge impact on health and disease prevention.

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Global warming and climate change:

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The increase in atmospheric carbon dioxide to date is primarily due to the developed regions of the world: Europe, the United States, Japan, New Zealand, Australia, etc. However, future emissions will be dictated to an increasing degree by emerging countries that are experiencing their own industrial revolutions, which are being largely driven by increased consumption of fossil fuels. While most developed countries saw their carbon dioxide emissions decline between 2006 and 2010, developing countries experienced sharp increases in carbon dioxide emissions over that time frame. In 2006, China displaced the U.S. as the largest global emitter of carbon dioxide. Since then, China’s carbon dioxide emissions have increased by 28%, or 1.8 billion metric tons. In addition to China, some of the countries that experienced double-digit growth in carbon dioxide emissions between 2006 and 2010 include Peru (49%), India (40%), Vietnam (37%), Singapore (36%), and Saudi Arabia (28%). The net result was that even as the U.S., Canada, the European Union, Australia, New Zealand, Japan, and Malaysia all saw declines in total carbon dioxide emissions over the past five years, global emissions grew by 11% over the same time frame. An examination of the past decade shows that economic development in the Asia Pacific region is the current driver behind growing global carbon dioxide emissions. Over the past decade, carbon dioxide emissions declined slightly in North America and the EU, but grew steadily across the Asia Pacific region. Further development of the region could see it become responsible for 50% of global carbon dioxide emissions within a decade Not only does the Asia Pacific region emit the most carbon dioxide, it has the highest carbon dioxide emissions growth rate of any region. Other developing regions—the Middle East, Africa, and South and Central America—have much lower overall emissions than both the Asia Pacific region and more developed regions, all developing regions are experiencing rapid growth in carbon dioxide emissions. This is understandable, considering that the majority of the world’s population lives in developing regions, and they seek to raise their standards of living. Developed countries have done that by burning fossil fuels, and developing countries seek the same modern conveniences—dishwashers, televisions, computers, and cars—enjoyed by the developed world and which are currently powered mostly by fossil fuels. Thus, due to growth in developing countries, global carbon dioxide emissions are likely to continue to increase in this decade just as they did in the past decade. If that trend is to be reversed, future development would need to take place without fossil fuels. This may be possible in theory, but no country has yet provided the blueprint to show that it can be done in practice. Consider again the per capita emissions of the United States, China, and India. While the U.S. has heavily subsidized and incentivized renewable energy, per capita emissions in the U.S. are still more than 3 times those of China and over 13 times those of India. It is one thing to imagine that developing countries could rely on renewable energy to develop without increasing their use of fossil fuels, but the reality is that the developed regions have not shown that it can be done. Thus, the developed world is in the poor position of asking developing countries to do something they themselves have not done. The U.S. consumes 9 times as much oil per capita as China, and 24 times as much as India—thus the U.S. is an order of magnitude beyond being able to demonstrate an appealing, low-fossil-fuel lifestyle for these countries. Environmental Kuznets curve (EKC) suggests that the level of environmental degradation (pollution) and per capita income follows inverted-U-shaped relationship so that environmental quality deteriorates in early stage of economic development/growth and improves in later stage as an economy develops. However corruption, a high degree of income inequality, low level of literacy, lack of political rights and civil liberties, may impede the development of the EKC relationship. This is the reason why EKC theory fails in many Indian states. So economic growth may facilitate some environmental improvements but this is not an automatic process and will only result from investment and policy initiatives.

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It is hypocritical and unfair for rich developed countries to demand that poorer nations make environmental conservation their priority. After all, they became rich in the first place by destroying their environment in the industrial revolution. They worked hard and developed their economies but at the cost of cutting down their own trees, polluting their water sources and poured billions of tons of carbon into the air; and so they are in no position to tell others to behave differently. Also one cannot overlook a fact that developed nations have displaced some of its environmental costs by shifting pollution producing factories to less prosperous and less powerful developing nations. Rich developed nations have a historical responsibility for global warming because their factories released carbon emissions into the atmosphere long before the climate effects were known. The climate change phenomenon has been caused by the industrialization of the developed world. Both the developed and the developing nations should come together to protect the environment. Instead of questioning each other’s duties, they should collectively strive for a solution and step up their efforts to save the environment. In fact, every county should do its bit. The 2015 United Nations Climate Change Conference was held in Paris, France, from 30 November to 12 December 2015. It was the 21st yearly session of the Conference of the Parties (COP) to the 1992 United Nations Framework Convention on Climate Change (UNFCCC) and the 11th session of the Meeting of the Parties to the 1997 Kyoto Protocol. The conference negotiated the Paris Agreement, a global agreement on the reduction of climate change, the text of which represented a consensus of the representatives of the 196 parties attending it.  According to the organizing committee at the outset of the talks, the expected key result was an agreement to set a goal of limiting global warming to less than 2 degrees Celsius (°C) compared to pre-industrial levels. The agreement calls for zero net anthropogenic greenhouse gas emissions to be reached during the second half of the 21st century. In the adopted version of the Paris Agreement, the parties will also “pursue efforts to” limit the temperature increase to 1.5 °C. The 1.5 °C goal will require zero emissions sometime between 2030 and 2050, according to some scientists. On 12 December 2015 the participating 195 countries agreed by consensus to the final global pact, the Paris Agreement, to reduce emissions as part of the method for reducing greenhouse gas. In the 12-page document the members agreed to reduce their carbon output “as soon as possible” and to do their best to keep global warming “to well below 2 degrees C”. France’s Foreign Minister Laurent Fabius said this “ambitious and balanced” plan was a “historic turning point” in the goal of reducing global warming.  However, some others criticized the fact that significant sections are “promises” or aims and not firm commitments by the countries.  James Hansen, one of the first scientists to warn about global warming, calls the just-completed Paris climate summit a fraud. And, of course, he is right. Strictly speaking, the summit was fraudulent. It committed none of the 195 nations attending to do anything substantive to combat global warming. It recycled goals of past United Nations climate-change summits without providing a mechanism for attaining them. It was welcomed by countries that emit large quantities of greenhouse gases because, ultimately, it required nothing of them. The truth is every country wants economic development and blame other countries for climate change.

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Developing countries switching to low carbon economy at twice the pace of developed nations: 2014 study:

Developing countries are increasing their clean energy capacity twice as fast as developed nations, a new study suggests. Climatescope 2014 analyzed 55 developing countries in Africa, Asia, Latin America and the Caribbean – which together represent almost half of Earth’s population and a quarter of global GDP. The stronger clean energy growth shown in developing nations contradicts the common belief that only developed countries have the means to switch to a low carbon economy. Demand for energy in general is dramatically increasing all around the globe. Between 2008 and 2013, the nations included in the report added 603 gigawatts (GW) of new energy capacity, with a total grid capacity of 2,013 GW – a rise of more than 30%. At the same time, the developed countries that are part of the Organisation for Economic Co-operation and Development (OECD) grew just 9.6%, with a total capacity of 2,887 GW. Report authors underscore that the lion’s share of this dramatic increase is in clean energy, not including hydroelectric power. For the same period the developing nations scrutinized added 142 GW of clean energy, an increase of 143%: more than France’s total capacity. OECD nations added 213 GW, which is a rise of 84%. Throwing in large hydroelectric capacity too, Climatescope nations have 666 GW of clean energy now installed, while the OECD countries have 806 GW. In addition, in developing countries renewable energy has a larger percentage in the total energy mix, when compared to developed nations.

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The figure above shows total cumulative power generating capacity (GW) and annual growth rate (%) in Climatescope countries vs. OECD Nations, 2008 – 2013, from Climatescope 2014 report.

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Developing nations need healthcare, education, employment incentives to curb climate change:

According to SUNY Canton’s Umesh Kumar, the way to get developing countries to reduce greenhouse gas emissions is by helping them solve three issues that are more pressing to them than climate change — the life expectancy, education and income levels of their people. Along with Social and Ecological Management Fund co-founder John Fay, Ph.D., Mr. Kumar, Ph.D., an assistant professor of financial services, authored a paper which looked at why some developing countries don’t take advantage of financial incentives to reduce emissions offered by first world nations. In the paper, which has been selected for publication in the international journal “Climate and Development,” Mr. Kumar argued that countries are less likely to take advantage of those incentives if they have a poor Human Development Index number, a statistic which ranks countries by combining life expectancy, education and individual income levels. Mr. Kumar said if a country has a value above 150, it is not likely to invest in green technologies because it has not met those needs, which are considered the “three basic dimensions of human development.”  Mr. Kumar said this is the case for sub-Saharan African countries like Sudan and Eritrea, which have an HDI of 166 and 182, respectively, according to United Nations data from 2013.  “We’ve found that the HDI is a crucial factor for a country to take advantage of the financial incentives to reduce greenhouse gases offered,” said Mr. Kumar in a SUNY Canton release last week. “The findings of this article suggest that countries that have not achieved a minimum service level of basic needs, or have a low HDI, are unlikely to commit the resources for reducing emissions, even with economic incentives.” By contrast, developed countries like Norway have an HDI ranking within the top ten, and larger developing nations like China come in under 100, in the U.N. data. In that same data, the U.S. was ranked fifth overall. With those statistics in mind, Mr. Kumar said countries with an HDI value above 150 should be offered additional incentives to improve their education, healthcare and employment systems, because when they address those issues, they realize why it’s important to reduce emissions. “Any society that has got a higher income level, better life expectancy and better education, they become more environmentally conscious,” he said, adding that new incentives should focus on children, who are more receptive to the idea of curbing climate change. “When you become more environmentally conscious, you are willing to commit the resources, you are willing to go for a green economy.”  He said this means developing nations would be more willing to work on updating their fossil fuel-based energy systems, and more willing to take advantage of the $100 billion offered to them as part of this year’s Paris Climate Change Conference. When asked for examples of incentives, Mr. Kumar supported the work being done by the Bill & Melinda Gates Foundation and Warren Buffett to improve education and eradicate polio in developing nations.  Mr. Kumar, who teaches in the finance program at SUNY Canton, has been recognized four times for his economics research, winning awards for papers he presented with SUNY Canton Criminal Justice Professor Brian K. Harte, Ph.D., at Academy of Business Research conferences in 2011, 2012, 2014 and 2015.

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Sustainable development:

The issue of sustainability adds another dimension to the concept of development. Sustainable development is “development that meets the needs of the present without compromising the ability of future generations to meet their own needs.” Some important factors that must be taken into account when discussing sustainable development are the rational use of natural resources and energy, pollution, and climate change. In development terms, sustainability means responsible growth—when social and environmental concerns are aligned with people’s economic needs. The current global development model is unsustainable, but it can be fixed. Rapid population growth and excessive consumption lay at the heart of the challenges to sustainable development. Civilization is faced with a perfect storm of problems driven by overpopulation, overconsumption by the rich, the use of environmentally malign technologies, and gross inequalities. This is not to discount the role that economic development has played in lifting billions of people out of extreme poverty and improving living standards around the world.

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Actions to address sustainable development:

•Value and Price in Environmental and Social Impacts:

The value of ecosystem services and natural capital must be incorporated in national accounting and decision-making processes across all sectors of society.  Factoring the full value of biodiversity and ecosystem services into decisions about energy production and use is a critical component of transitioning from climate-changing fossil fuels to renewable energy sources.

•Grow Green:

Low-carbon, green growth is the only sound basis for a sustainable recovery from the prolonged economic slowdown in developed countries.  If existing barriers are lowered and technologies scaled up accordingly, the share of renewable energy in global primary energy could increase to 30 to 75 percent.

•Empower Girls and Women:

Involving girls and women makes development efforts more effective, improves well-being and reduces inequality.  Women have critical parts to play in increasing agricultural productivity and managing the environment.

•Adapt to Climate Change:

Climate change is real and inevitable.  Even in the best case scenarios, countries need to take action to minimize the threats to living environments and loss of economic opportunities.

•Define and Operationalize Sustainability:

A clear, working definition and set of guiding principles for pursuing sustainability is “mandatory” for evaluating trade-offs, calculating potentials and impacts and cooperating across sectors and disciplines.

•Cooperate Regionally:

Regional cooperation has often proven more effective than more expansive global cooperation efforts.  The Association of Southeast Asian Nations (ASEAN) is cited as an example of a regional grouping of countries that has developed a common vision and interests which can facilitate the pursuit of sustainable development.  Successful regional efforts can also “grow into global building blocks.”

•Mainstream Grass Roots Action and Solutions:

The community groups, often in poor, rural areas ought to influence regional and national policy. The answer to addressing poverty and climate change is primarily social rather than technical.

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Can India become a developed nation?

In the recently published Human Development Report 2015, it was unveiled that India has been placed at 130th position in the 2015 Human Development Index (HDI) among the 188 countries. With a score of 0.609 on HDI, India stands well below the average score of 0.630 for countries in the medium human development group. But it is marginally above the South Asian countries’ average score of 0.607. According to the latest ranking, India stands higher than neighbours Bangladesh and Pakistan but lower than countries like Namibia, Guatemala and Tajikistan, even Iraq. According to International Monetary Fund World Economic Outlook (April-2015), GDP (nominal) per capita of India in 2014 at current prices is $1,627 compared to $1,508 in 2013. India is the ninth largest economy of the world. But, due to its huge population of more than 1.26 billion, India is at 145th position in term of GDP (nominal) per capita. Per capita income of India is 6.69 times lower than world’s average around of $10,880. This figure is 68.66 times lower than richest country of world and 6.5 times greater than poorest country of the world. India is at 34th position in the list of Asian countries. On the basis of PPP, GDP per capita of India stands at 5,855 International Dollar in 2014. GDP PPP per capita of world is 15,189 Int. $. World rank of India is 125 and Asian rank is 30. Despite the good economic performance, with over 200 million people who are food insecure, India is home to the largest number of hungry people in the world. In the ranking of the Global Hunger Index 2008 it covers position 66 out of 88 ranked countries and has an “alarming“ (23.7) food security situation. India is home to 194.6 million undernourished people, the highest in the world, according to the annual report by the Food and Agriculture Organization of the United Nations released in 2015. This translates into over 15 per cent of India’s population, exceeding China in both absolute numbers and proportion of malnourished people in the country’s population. Higher economic growth has not been fully translated into higher food consumption, let alone better diets overall, suggesting that the poor and hungry may have failed to benefit much from overall growth. The development project in India is nowhere near complete – indeed it has barely begun. Development is supposed to involve job creation, with more workers in formal employment in large units, but that has not happened. Manufacturing still counts for less than one-fifth of both output and employment. More than half of all workers languish in low productivity agriculture, while another quarter or so are in low grade services. About 95% of all workers are in informal employment, and roughly half are self-employed. What’s more, the recognised and paid participation of women in working life has actually been declining in a period of rapid income growth. This basic failure helps to explain several other failures of the development project so far: the persistence of widespread hunger and very poor nutrition indicators; the inadequate provision of basic needs like housing, electricity and other essential infrastructure; the poor state of health facilities for most people; and the slow expansion of education. Growing inequalities do mean that a rising middle class is emerging, but this should not blind us to the lack of fulfilment of basic social and economic rights for the bulk of people.

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Here are some factors affecting India in its journey to become a developed nation.

1. Education:

The present education scenario, although a little better than the last decade, is quite dismal. Factors affecting India in the education sector:

–Poor standards of literacy: The Indian government has decided very low bars for calling a person literate. In order to show high percentages of literacy, the actual standards of literacy are quite below par. So in spite of the figures, India is not really growing.

–Very high student to teacher ratio and resulting stagnation of village education: This is one factor which is a constant roadblock in our road to success. The average student to teacher ratio in India is almost twice as that in US or even China. As a result, very few students actually come to school and learn whereas the rest just waste their time. Because of the scarcity of teachers, enthusiastic students do go to their village schools but there are no teachers to teach there.

–Privatisation of education: More and more schools are being privatised in India. The government schools were established for a purpose to teach the under-privileged sections of society. But more and more privatisation of schools means that more teachers will drift away from govt to private schools. Also these schools charge fees according to their whims making it difficult even for a middle class family to educate their child. Also private tuition classes dominate education in big cities and even towns.

–Reservation: The increasing percentage of reservation in India’s A listed colleges is an enormous thorn in India’s path. Deserving candidates are sacrificed for a bunch of less deserving candidates belonging to lower caste. The blow itself disheartens the deserving child and hence curbs his inner fire, once and forever.

–Increasing number of drop-outs: The number of students acquiring higher education from primary education goes steadily decreasing.

2. Economy:

It is believed that economic reforms started in early 1990s are responsible for the fall down of rural economy in India. It also led to the agrarian crisis. Because of high debt, poor farmers are left with no other choice than to commit suicide. According to official statistics, number of farmers committing suicides has also increased since 1997. The new policies by the government encourage farmers to switch to cash crops in place of traditional crops. But this has led to a manifold increase in farm input cost which ultimate resulted in the economic burden and thus poverty. Also villages in India are not self-sufficient like they used to be. The rural youth is mostly not well educated, lack skill and even not interested in farming. All these are enough for a disastrous and poor future. Government should come up with plans to make villages self-reliant. Skill based education must be provided to the youth.

3. Corruption:

India, if not completely but is almost synonymous with the word corruption. Numerous scams in the recent years explain the saga of corruption. Almost all the government departments are affected from it. Corruption is regarded as one of the biggest reasons of poor development in India. Corruption in the Public Distribution System (PDS) is the worst of its kind.  The leading source of corruption in India is entitlement programmes and social spending schemes that are meant for the welfare of our society.  For an example – Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA),is a $9 billion program planned to offer 100 days of employment annually for the rural poor. But MNREGA failed because of corruption and mismanagement.  Just like MNREGA, the National Rural Livelihood Mission met the same fate. It was planned to empower. Though government is putting efforts to have an “inclusive growth” but corruption is playing its role. So all such programs designed for poor and needy failed to impress and help them. Instead poor are even denied of their basic right and needs. Corruption is just like an endemic in India. It leads to social inequalities and hits economy of nation. Funds granted to uplift the poor are misused. Poverty is further worsened by the administrative corruption. Even the simplest of the task is not performed without a bribe. Corruption also delays and diverts the economic growth. As per the data compiled by Bloomberg, near about $14.5 billion in food was plundered by the corrupt politicians in the state of Uttar Pradesh. The loot caused poor to survive without the required quantity of food and children to suffer from malnutrition. There are many other cases of administrative corruption further deterioration the situation and making poor poorer.

4. Judicial Incapability:

This is the most undervalued point during the development of any nation but is equally important. A better use of time would be possible if the cases are heard and solved. Hence the judge to people ratio should be improved.

5. High population growth rate:

It is rightly said that excess of everything is bad. This is true in this case as well. More people mean the need of more resource, food etc. If this surplus is trained in a right way only then it can take part in the economic development of the country.

6. Ever increasing economic inequality:

India’s growth model for sure has benefitted the businessmen but failed when we see that near about 213 million Indians go hungry every night. Rights of organized as well as unorganized workers are being violated. They are underpaid and not paid according to the industrial growth and ever rising inflation. Due to such a visible inequality each year thousands of girls are sexually exploited and trafficked for money. At the same time child labour has also increased. Wealthy are acquiring more wealth. In such an unequal scenario, top 5% of households have 38% of the total assets of India whereas bottom 60% has merely 13% of the assets.

7. Environmental degradation:

Environmental issues in India are many. Air pollution, water pollution, garbage pollution and wildlife natural habitat pollution challenge India. The situation was worse between 1947 through 1995. According to data collection and environment assessment studies of World Bank experts, between 1995 through 2010, India has made one of the fastest progress in the world, in addressing its environmental issues and improving its environmental quality. Still, India has a long way to go to reach environmental quality similar to those enjoyed in developed economies. Pollution remains a major challenge and opportunity for India.

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My view on India becoming developed nation:

After living in India for 48 years, I know India more than any westerner knows. In my view India will not become a developed nation for 100 years. India has population of 1.25 billion people but it cannot be considered as human capital because 80 % of Indians are uncivilized, undisciplined and unskilled. Instead of improving economic growth, they bring down all economic indices. They do not want to work hard to earn livelihood but depend on government’s welfare scheme for survival. Since they are massive in number for electoral purpose, no political party can antagonize them and so there is competition among political parties to please them with more and more welfare schemes. Welfare programs destroy incentives for the poor to work; and people are reluctant to work because pay is not linked to work for everybody. India is a classic example of these two economic maladies. The human capital has become drawback. No politician wants to control population as it hurts their electoral prospects. Despite abundant natural resources, India remains developing nation due to lazy, unskilled and unhealthy labour force and inefficient utility of natural resources. Corruption and reservation are other barriers to development. Almost all Indian data including economic data are incorrect due to poor data collection. So whatever GDP per capita is calculated is grossly incorrect and overestimated to please the elite of the nation. The elite of the nation include politicians, bureaucrats, corporates and media; the gang of four. This gang of four has consistently looted India just as British Empire was looting India during their colonial rule. Although India has democracy for 68 years, all democratic institutions are poorly developed including judiciary resulting in poor governance. Elections are fought on emotional issues rather than policies. Vote bank politics means electorates vote with herd mentality rather than thinking which candidate shall bring development to their constituency. Electoral system is faulty resulting in a party getting 280 seats out of 543 with 30 % vote share. India needs great political leaders to push the nation in a forward direction.

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How can developing nations become developed nations?

The fundamental driving force behind all human and economic activity is survival and self-preservation. It is an inherent part of our collective psyche and impacts human behaviour regarding all areas, including economic growth. Those less privileged in developing countries adhere to this philosophy as much, if not more, than in the West. It is therefore unwise to expect the despaired masses of the global South, who number in the billions, to forego this basic demand of survival so that the West can live with the guilt of centuries of industrial pollution and environmental degradation. Let there be no double standards or historical ignorance when it comes to matters of life and death, literally. In other words, developing nations can become developed nations by heavy industrialization with resultant increased emissions, pollution and environmental degradation. These adverse effects of development are undesirable although unavoidable.

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A country is made developed by its citizens and other natural resources. Impact of natural resources is limited and also depends on the citizens to unearth them and route them to the economy. However, citizens are the most prized asset for a developed country. It is a hen and egg scenario where flourishing of either aids the growth of another. Qualified citizens are attracted to developed countries and developed countries are built by talented citizens who contribute to its economy. The biggest difference among the countries in this respect is the culture of doing better business including the culture of entrepreneurship. Compared to the overall population, there are higher number of businessmen and entrepreneurs in developed countries, who not only aim to flourish in their own country but tend to spread across the world. This hunger earns the economy precious foreign exchange reserves and doing good business aids the tax coffers of the government. Foreign exchange reserves increase the value of the currency and the citizens get a higher value in exchange for goods and services from other countries. All developed countries, have a stronger currency and sell more than they buy in the international markets. Richer governments have money at their disposal for development and infrastructure. Only countries who have tasted success in investing in R&D and have been able to sell that technology to other countries at huge profits, are able to spend mammoth investments in R&D. More business generated by the citizens leads to more employment and more taxes, both of which contribute directly or indirectly to the economy. If developing country needs to become a developed economy, it needs to start doing better trade and business than developed countries. The three pillars of developmental economics are poverty alleviation, reduction in unemployment and reduction in inequality. The human developmental index falls short of the target of development when there is wide spread poverty, inequality and unemployment prevailing. So it is not a reliable measure of development. No human development index can measure the level of Tort prevailing in an economy unless people love each other, entertain written and unwritten contracts and maintain value of their words. This high level of manifestation of Tort which is the obligation and duty arising without written contract between each citizen is a highly civilized form of existence of societies. This level of civility for existence can be achieved only by addressing the issues of poverty alleviation, inequality and unemployment.

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Among the many frustrations in development, perhaps none looms larger than the “resource curse.” Perversely, the worst development outcomes–measured in poverty, inequality, and deprivation–are often found in those countries with the greatest natural resource endowments. Rather than contributing to freedom, broadly shared growth, and social peace, rich deposits of oil and minerals have often brought tyranny, misery, and insecurity to these nations. The correlation between energy dependence and authoritarianism is clear. There are twenty-three countries in the world that derive at least 60 percent of their exports from oil and gas and not a single one is a real democracy. There are numerous hypotheses to account for this correlation. Most obviously, easy resource revenues eliminate a critical link of accountability between government and citizens, by reducing incentives to tax other productive activity and use the revenue to deliver social services effectively. The same revenues also generate staggering wealth that facilitates corruption and patronage networks. Together, they consolidate the power of entrenched elites and regime supporters, sharpening income inequality and stifling political reform. The history of the oil-rich Arab Middle East has long been a case in point–with Saudi Arabia being classic example. Even when oil abundance produces high growth, it often benefits only a few corrupt elites rather than translating into higher living standards for most of the population. Oil-rich Angola is a case in point. Despite having one of the world’s highest growth rates from 2005 to 2010, averaging some 17 percent annually, its score on the human development index remained a miserable 0.49, and its infant mortality rate was lower than the sub-Saharan African average. The very presence of oil and gas resources within developing countries exacerbates the risk of violent conflict. The list of civil conflicts fought at least in part for control of oil and gas resources is long. A partial list would include Nigeria, Angola, Burma, Papua New Guinea (Bougainville), Chad, Pakistan (Balochistan), and of course Sudan. Econometric studies confirm that the risk of civil war greatly increases when countries depend on the export of primary commodities, particularly fossil fuels. At least three factors could explain this correlation. First, the prospect of resource rents may be an incentive to rebel or secede. Second, wealth from resources may enable rebel groups to finance their operations. Third, the high levels of corruption, extortion, and poor governance that accompany resource wealth often generate grievances leading to rebellion. Only democracy with strong democratic institutions, good governance and rooting out corruption can make them developed nation.

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The Rise of the new development policy, the Washington consensus:

During the 1980s, four important events contributed to advent of new development model. First, developing countries that had followed highly interventionist policies most faithfully had some of the poorest growth records. Second, the GDP growth rates of the more industrialized countries of Eastern Europe and the Soviet Union that had followed interventionist approaches to their own growth were visibly falling behind those of the market-based economies. Third, Taiwan, Singapore, South Korea, and Hong Kong, which had departed from the accepted model by adopting more market-based policies, were prospering and growing rapidly. Fourth, the globalization of the world’s economy led to an understanding that countries could no longer play a full part in world economic growth without a substantial presence of multinational corporations within their boundaries. Given the sizes of developing countries, this meant the presence of foreign owned multinationals. Let us discuss each of these four events in more detail.

1. Experience of the Developing Countries:

Highly interventionist economies fared poorly in the 1950s, 1960s, and 1970s. Economies as varied as Argentina, Myanmar (then Burma), Tanzania, Ethiopia, and Ghana were all interventionist and all grew slowly, if at all. In Ethiopia, the emperor was overthrown and the new government adopted rigid Soviet-style policies. Attempts to collectivize agriculture led, as they had 50 years previously in the Soviet Union, to widespread famine. Some countries, such as Ghana, Nigeria, and Myanmar, started from relatively strong economic positions when they first gained their independence but later saw their GDPs and living standards shrink. Other countries, such as India and Kenya, sought a middle way between capitalism and socialism. They fared better than their more highly interventionist neighbours, but their development was still disappointingly slow.

2. Experience of the Socialist Countries:

In the years following the Second World War, many observers were impressed by the apparent success of planned programs of “crash” development, of which the Soviet experience was the most remarkable and the Chinese the most recent. Not surprisingly, therefore, many of the early development policies of the poorer countries sought to copy the planning techniques that appeared to underlie these earlier socialist successes. In recent decades, however, the more developed socialist countries began to discover the limitations of their planning techniques. Highly planned government intervention seems most successful in providing infrastructure and developing basic industries, such as electric power and steel, and in copying technologies developed in more market oriented economies. However, it is now seen to be much less successful in providing the entrepreneurial activity, risk taking, and adaptivity to change that are key ingredients to sustained economic growth and technological change. The discrediting of the Soviet approach to development was given added emphasis when the countries of Eastern Europe and the former Soviet Union abandoned their system en masse and took the difficult path of rapidly introducing market economies. Although China, the last major holdout, posted impressive growth figures in the 1990s, two “nonsocialist” reasons are important in explaining its performance. First, over 90 percent of the population is engaged in basically free-market agriculture—because that sector has long been free of the central-planning apparatus that so hampered agriculture in the former Soviet Union. Second, while the state-controlled industries suffer increasing inefficiencies, a major investment boom took place in China’s southeast coastal provinces. Here foreign investment, largely from Japan and the Asian NICs, introduced a rapidly growing and highly efficient industrialized market sector.

3. Experience of the NICs:

South Korea, Taiwan, Hong Kong, and Singapore—the so-called Asian Tigers—have turned themselves from relative poverty to relatively high income in the course of less than 40 years. During the early stages of their development, they used import restrictions to build up local industries and to develop labour forces with the requisite skills and experiences. In the 1950s and early 1960s, however, each of the four abandoned many of the interventionist aspects of the older development model. They created market-oriented economies with less direct government intervention than other developing economies, which stuck with the accepted development model. Korea and Singapore did not adopt a laissez faire stance. Instead, both followed quite strong policies that targeted specific areas for development and encouraged those areas with various economic incentives. In contrast, Hong Kong and Taiwan have had somewhat more laissez faire attitudes toward the direction of industrial development. After local industries had been established, all four adopted outward-looking, market-based, export-oriented policies. This approach tested the success of various policies to encourage specific industries by their ability to compete in the international marketplace. With industries designed to serve a sheltered home market, it is all too easy to shelter inefficiency more or less indefinitely. With export-oriented policies not based on subsidies, the success of targeted firms and industries is tested in international markets, and unprofitable firms fail. Not far behind the NICs is a second generation of Asian and Latin American countries that have also adopted more market-oriented policies and have seen substantial growth follow. Indonesia, Thailand, the Philippines, Mexico, Chile, and Argentina are examples. Even Vietnam and Laos are liberalizing their economies as communist governments come to accept that a market economy is a necessary condition for sustained economic growth.

4. Globalization:

At the heart of globalization lies the rapid reduction in transportation costs and the revolution in information and communication technology that has characterized the past two decades. One consequence has been that the internal organization of firms is changing to become less hierarchical and rigid and more decentralized and fluid. Another consequence is that the strategies of transnational corporations (TNCs), which span national borders in their organizational structures, are driving globalization and much of economic development. Because most trade, and much investment, is undertaken by TNCs, no country can develop into an integrated part of today’s world economy without a substantial presence of TNCs within its borders. The importance of TNCs is now recognized, and most aspiring developing countries generally put out a welcome mat for them. Historically, only a few countries, notably Japan and Taiwan, have industrialized without major infusions of foreign direct investment (FDI). Moreover, these cases took place before the globalization of the world’s economy. It is doubtful that many (or any) of today’s poor countries could achieve sustained and rapid growth paths without a substantial amount of FDI brought in by foreign-owned transnationals. Without such FDI, both the transfer of technology and foreign networking would be difficult to achieve. Developing countries have gradually come to accept the advantages of FDI. First, FDI often provides somewhat higher-paying jobs than might otherwise be available to local residents. Second, it provides investment that does not have to be financed by local saving. Third, it provides training in worker and management skills that come from working with large firms linked into the global market. Fourth, it can provide advanced technology that is not easily transferred outside of the firms that are already familiar with its use.

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The Washington Consensus:

As a result of these various experiences, a new consensus on development policy emerged in the closing decades of the twentieth century. The revised model calls for a more outward-looking, international trade-oriented, and market-based route to development. It calls for accepting market prices as an instrument for the allocation of resources. This means abandoning both the heavy subsidization and the pervasive regulations that characterized the older approach. But it also calls for a careful use of government policy in providing basic infrastructure, public goods, and dealing with market failures. This consensus is often referred to as the “Washington Consensus.” It describes the conditions that are believed to be necessary for a poorer country to get itself on a path of sustained development. These views are accepted by a number of international agencies, including the World Bank, the IMF, and several UN organizations. The main elements of this consensus are as follows:

1. Government should adopt sound fiscal policies that avoid large budget deficits. In particular, persistent structural (or cyclically adjusted) deficits should be avoided.

2. Government should adopt sound monetary policies, with the goal of maintaining low and stable inflation rates. Exchange rates should be determined by market forces rather than being pegged by central banks.

3. The tax base should be broad, and marginal tax rates should be moderate.

4. Markets should be allowed to determine prices and the allocation of resources. Trade liberalization is desirable, and import licensing, with its potential for corruption, should be avoided.

5. Targeted protection for specific industries and a moderate general tariff, say, 10 to 20 percent, may provide a bias toward widening the industrial base of a developing country. But such protection should be for a specified period that is not easily extended.

6. Industrial development should rely to an important extent on local firms and on attracting FDI and subjecting it to a minimum of local restrictions that discriminate between local and foreign firms. (Of course, restrictions will be required for such things as environmental policies, but these should apply to all firms, whether foreign owned or locally owned.)

7. An export orientation (as long as exports do not rely on permanent subsidies) provides competitive incentives for the building of skills and technologies geared to world markets, permits realization of scale economies, and provides access to valuable information flows from buyers and competitors in advanced countries.

8. Education, health (especially for the disadvantaged), and infrastructure investment are desirable forms of public expenditure. Because future demands are hard to predict and subject to rapid change, a balance must be struck between training for specific skills and training for generalized and adaptive abilities.

9. Finally, emphasis needs to be placed on poverty reduction for at least two reasons. First, poverty can exert powerful antigrowth effects. People in poverty will not develop the skills to provide an attractive labour force, and they may not even respond to incentives when these are provided. Malnutrition in early childhood can affect a person’s capacities for life. Second, although economic growth tends to reduce the incidence of poverty, it does not eliminate it.

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Economic growth to economic security:

As incomes have risen over the course of the twentieth century, citizens in nearly all the industrial countries have shifted their public priorities from economic growth to economic security. The bulk of the increases in government spending in rich countries have gone for programs such as insurance for health, unemployment, work-related accidents, and retirement. These same programs lie behind the rise in taxes relative to national output. In Western Europe, economic-security programs typically take 25% to 30% of national output, an amount equal to the rest of all government activities and far greater than the U.S. outlay. While the rich countries dismantled the protective systems at their borders, they erected new offsetting protective systems within. People’s priorities change as their incomes rise; spending for food and shelter as a percentage of income shrinks even as the food and shelter get better. Spending on health care, most of which is financed by some form of insurance, has risen from 8% to 15% of U.S. output since 1970. Like other aspects of the welfare state, it is designed to promote increased economic security. Though mostly private, and thus, in a sense, more free, the U.S. health-care system is at the same time the most expensive in the world. It is in large measure a tax on the community. The prosperous Asian countries have taken a different but parallel tack. Social spending in Japan is far less extensive than in the West, as government has officially left citizens to provide their own security to a far greater degree. But the government has implicitly encouraged corporations to provide much of that security in its stead.

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Are people in developing world not as intelligent as developed world?

Intelligence of population and development of nation:

IQ and the Wealth of Nations is a 2002 book by Richard Lynn, Professor of Psychology, and Tatu Vanhanen, Professor of Political Science. The book argues that differences in national income (in the form of per capita gross domestic product) are correlated with differences in the average national intelligence quotient (IQ). The authors further argue that differences in average national IQs constitute one important factor, but not the only one, contributing to differences in national wealth and rates of economic growth. The authors believe that average IQ differences between nations are due to both genetic and environmental factors. They also believe that low GDP can cause low IQ, just as low IQ can cause low GDP. The authors write that it is the ethical responsibility of rich, high-IQ nations to assist poor, low-IQ nations financially, as it is the responsibility of rich citizens to assist the poor. In several cases the actual GDP did not correspond with that predicted by IQ. In these cases, the authors argued that differences in GDP were caused by differences in natural resources and whether the nation used a planned or market economy. One example of this was Qatar, whose IQ was estimated by Lynn and Vanhanen to be about 78, yet had a disproportionately high per capita GDP of roughly USD $17,000. The authors explain Qatar’s disproportionately high GDP by its high petroleum resources. Similarly, the authors think that large resources of diamonds explain the economic growth of the African nation Botswana, the fastest in the world for several decades. The authors argued that the People’s Republic of China’s per capita GDP of at the time roughly USD $4,500 could be explained by its use of a communist economic system for much of its recent history. The authors also predicted that communist nations whom they believe have comparatively higher IQs, including China, Vietnam, and North Korea, can be expected to rapidly gain GDP by moving from centrally planned to more market based economic systems, while predicting continued poverty for African nations no matter their economic systems.  Critical responses have included questioning of the methodology and of the incompleteness of the data, as well as of the conclusions. Richardson (2004) argued, citing the Flynn effect as the best evidence, that Lynn has the causal connection backwards and suggested that “the average IQ of a population is simply an index of the size of its middle class, both of which are results of industrial development”.  A 2013 research paper shows how the differences in the timing of agriculture transition and the histories of States, not population IQ differences, predict international development differences before the colonial era. The average IQ of populations appears to be endogenous, related to the diverse stages of nations’ modernization, rather than being an exogenous cause of economic development.

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People in developing countries have lower IQs because their bodies are focused on surviving:  a 2010 study:

People in developing countries have lower IQs because their bodies divert energy from brainpower to fighting disease, researchers claimed. In hot nations blighted by deadly infections, the priority is survival and populations have evolved to develop stronger immune systems rather than intelligence, according to the controversial theory. U.S. researchers claimed their work could explain why national IQ scores vary around the world and are lower in some warmer countries stricken by diseases such as malaria, tetanus and tuberculosis. Infection could have as important an impact on intelligence as education, diet and wealth, said researcher Randy Thornhill and a team from the University of New Mexico. Children under five use most of their energy for brain development and this can be restricted if the body has to fight disease, they wrote in the Proceedings of the Royal Society. They compared data from worldwide IQ studies with disease maps drawn up by the World Health Organisation and concluded that the higher the level of infectious disease in a country, the lower the average national IQ.  ‘The effect of infectious disease on IQ is bigger than any other single factor we looked at,’ said Chris Eppig, lead author on the paper.  Disease is a major sap on the body’s energy, and the brain takes a lot of energy to build. If you don’t have enough, you can’t do it properly. ‘The consequence of this, if we’re right, is that the IQ of a nation will be largely unaffected until you can lift the burden of disease.’ Critics of the study argued there are many different kinds of intelligence that Western academic-based IQ tests fail to measure. Low IQ does not necessarily equate to stupidity or incompetence, they said. People in hot countries have the intellectual skills to survive in very difficult environments. The research could be abused to rationalise racism, just as the Nazis perverted scientific study in the 1930s, some critics said. Some critics warned the study could become an excuse for racism if it was used to suggest that people in the Third World are not as intelligent as those in cooler, richer climes. Experts pointed out that children fighting debilitating disease are likely to miss a lot of school, which could be the real reason for a lower IQ score, not compromised brain development. Professor Richard Lynn of Ulster University said the picture was complex, with low national IQs partly propagating the spread of infectious diseases.  HIV had a high infection rate in low-IQ nations, he said, because people did not understand how it was contracted and relied on baseless superstitions to avoid it.

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My view:

In my view, Worldwide IQ map shows Chinese population to be most intelligent but yet they are neither democratic nor developed nation. According to Lynn, Chinese did not become developed nation because they have centrally planned economy due to communism most of the time and only recently shifted to free market economy. In other words, had Chinese adapted to democracy with free market economy, they would have become developed nation long back. Who does not want better standard of living? If Chinese were so intelligent, they would have adapted democracy and free market economy long back. In other words, either Chinese are not intelligent or intelligence has nothing to do with development.  That means methodology of IQ measurement of population worldwide is faulty or high average IQ of a nation does not make it developed nation by itself.

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Genes vs. environment vis-à-vis nation development: Korea model:

North vs. South Korea:

In the last days of World War Two, when it became clear Japan would surrender to the Allied powers, the question of what would happen to Korea became louder than ever. After decades of occupying the Korean peninsula, Japan had retreated. The United States and Soviet Union agreed to divide Korea at the 38th parallel in August 1945, with the US taking the southern part and the Soviet Union the north. The plan was to hand back control to the Koreans and withdraw, and in 1948 several attempts were made at getting the nations to vote for reunification. But the distrust engendered by a few years of opposing ideologies had grown too deep. What started as an almost “accidental division” gave rise to one of the most hostile and heavily militarized borders in the world, and split one people in two. There is still no official peace between North and South Korea, despite the Korean War ending more than 60 years ago. Citizens remain separated by the “demilitarized zone” (DMZ), one of the most heavily armed borders in the world. Around 600,000 South Korean and 28,500 US troops face off against an estimated 770,000 North Korean soldiers stationed within 80 kilometers of the DMZ. While South Korea has turned itself into a technological superpower, North Korea’s government has struggled to supply its citizens with even basic foodstuffs. The UN estimates that more than a quarter of children under five show signs of chronic malnutrition.

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North Korea:

North Korea, a communist country led by the dynasty politics, is one of the most isolated economies in the world today. The doctrines of juche (self-reliance) and songun (military-first) have created a repressive atmosphere in the state. North Korea is often labelled an unreformed dictatorial economy. The nation that places its nuclear ambition over economic development has also time and again faced sanctions by the US and the European Union. The state receives much aid and concessionary assistance from international bodies like the United Nations and a handful of countries, particularly China. The North Korean economy deeply relies on its ally mainland China for economic and diplomatic support. This dependence makes the North Korean policy of juche impossible. The economic growth of the country has been fragile except during a short phase in the 1960s. North Korea faced its worst nightmare in 1990s as the region was hit by a series of natural disasters that kept its economic growth negative for a decade. Gradually, as the Sino-DPRK economic alliance strengthened, the nation started to develop Special Economic Zones (SEZs) to promote investment in the region. However, while North Korea may not be economically advanced, it does have plenty of unexplored natural resources, estimated to be worth trillions of dollars (most estimates give a figure of $6-$9 trillion). This is one reason why countries like China and Russia are enthusiastic about investing in DPRK.

South Korea:

The “miracle of the Han River,” as South Korea’s spectacular economic growth is popularly called, has transformed a nation that was once wracked by political chaos and poverty into a “trillion dollar club” economy. The country has clocked an average annual growth rate of seven percent, experiencing contraction only during two years. South Korea became a part of the Organization for Economic Cooperation and Development (OECD) in 1996, which marked its development into a rich industrialized nation. In 2004, it joined the elite club of trillion-dollar economies and today it ranks as the world’s 12th largest economy in terms of GDP. The economy of South Korea is multiple times (36.7 times as per current figures) that of North Korea’s in terms of GDP. According to 2013 figures, the GDP of North Korea is estimated at $33 billion, while that of South Korea is $1.19 trillion. The GDP per capita is $33,200 in South Korea, while it is $1,800 in the North. South Korea’s trade volume was a gigantic $1.07 trillion in 2013. By comparison, North Korea reported a relatively minuscule $7.3 billion. While North Korea runs a huge trade deficit, exports (goods and services) play an important role in South Korea’s growth story. According to World Bank data, exports of goods and services accounted for 53.9 percent of the GDP in 2013.

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Country North Korea South Korea
Population 24,720,407 48,955,203
GDP (purchasing power parity), $bn 40 1,622
GDP – real growth rate (%) 0.8 2.7
GDP – per capita (PPP), $ 1,800 32,400
Unemployment rate, % 3.8
Urban population (%) 60 83
Median age 33 39
Infant mortality rate, per 1,000 live births 26.21 4.08
Life expectancy at birth (total population) 69.2 79.3
Area 122,762 sq km 99,313 sq km
Corruption Index ranking 2012 174 45
Press Freedom Index 2013 178 50
Total executed, 2007-2011 105 0
Total sentenced to death, 2007-2011 0 13
CO2 Emissions (metric tons per capita) 3.1 10.4
% of rural population with access to an improved water source 97 88
Internet users per 100 people < 0.1 81.5
Intentional homicide, rate per 100,000 population 15.2 2.6
Intentional homicide, count per 100,000 population 3,658 1,251
Exports, $ billion 4.71 552.6
Imports 4 514.2
Net official development assistance (ODA) and official aid (current US$) 78,840,000 -69,070,000
Net ODA per capita (current US$) 3
Global Hunger Index score 19 N/A
Active duty military 1190000 655000
Reserve 600,000 (Armed Forces). Paramilitary 5,700,000 4,500,000. Paramilitary 3,000,000
Military expenditure as a percentage of GDP 22.3 2.8
Military spending, $ billion 8.21 26.1

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How did South Korea become a developed nation?

Stage 1: Achieving 100% literacy:

By 1940s, South Korea already had a fairly literate population by Asian standards of that time. This was partly because of Japanese occupation. While democracy and human rights suffered, Japanese have been quite instrumental in building Korea’s infrastructure and also strongly integrated the economy with Japan. That proved to be valuable in an export game in the following decades. Soon after the division of the Korean Peninsula, in 1945, South Korea already had in place the building blocks for growth: an educated population, property rights, land reform that boosted productivity, and the institutions of modern capitalism.  After the war, the South Korean government took a significant step in expanding the reach of literacy to all. This eliminated illiteracy by the 1960s giving it a significant advantage compared to most Asian countries. Human capital is the foundation of a developed nation.

Stage 2: Land reforms:

One of the most understated economic factor is land reforms. It is extraordinarily important for growth and peace. Land reforms make or break a nation. In Korea, key land reforms happened in late 1940s that built a significant middle class. It was partly done by the US who forced the Japanese land owners out and redistributed the property. In Korea and Taiwan, the absence of powerful economic interests and low levels of inequality due to sweeping land reform contributed to developing meritocratic and autonomous bureaucracy, which helped to curb corruption and capture.

Stage 3: Market Reforms:

Literacy and land reforms are necessary, but not sufficient conditions for growth. South Korea was still poor in 1960s, until the stage 3 in growth came. In fact, it was just rubbing shoulders with North Korea until then. Park Chung-hee forcefully took the country towards a freer market and opened up the economy. He also deepened the relationship with US and Japan. That’s where you start seeing the curve moving up.

Stage 4: Demographic Shift:

This is again an understated effect. Countries that have gone through a first phase of growth will have rapidly falling population growth rate leading to a virtuous circle for a while. People focus more on career than families – leading to fewer children. In the initial few decades this is a great advantage – as people will rapidly move up in career ladder and would not have kids to slow them down. They will get richer and mobile. Things all go well until it comes time for retirement. Then, all the things about putting career over family bites. In short, demographic shift is a one-time growth lottery that Japan and Korea used well. However, the lottery’s “high” wears off at some point and the hangovers are very severe. Japan is going through this painful process and South Korea has just started.

Other factors:

1. Constant threat from North Korea. This keeps South Koreans on their toes giving them no opportunity to go lax.

2. Lots of help from the US. At one point 60% of all investment came from the US. Of course, it doesn’t hurt to be a US ally.  The difference from Middle East allies of US is that South Korea did make its citizens literate, give them land and open up the economy, without which US Aid would have been ineffective.

In a nutshell:

South Korea’s growth is a combination of quick achievement of 100% literacy that started in Japanese occupation, significant land reforms that created the middle class, significant market reforms that helped the middle class trade with the world and a demographic one-time lottery. Most communist nations miss the stage 3 thus they are educated with land reforms with stunted growth. Many crony capitalist nations miss stages 1 & 2, thus they have a “free” market but without a populace that is educated and with land to make use of the market. South Korea ticked off all its boxes.

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My view:

North Korea has kept itself aloof from the outside influence, with its people living under regulations in a controlled environment. Between its impoverishment and its nuclear armament, it is hard to say what the future of North Korea will be like. But for now, it is a classic example of a secluded totalitarian economy. South Korea, on the other hand, is westernized and advanced. The country has moved very fast on the path of growth, from a war-devastated state into an economic powerhouse.

North Korea South Korea
Political system Dynasty Democracy
Economic system Centrally planned Free market economy
Military spending  22 % of GDP  2.8 % of GDP
Economic structure Agriculture based Industry based
Freedom No freedom Full freedom

You can see the difference between underdeveloped North Korea and highly developed South Korea.

So do genes or environment make a developed nation?

The Korean example gives answer. Till 1945, all Korean people were one people, having genetic homogeneity and same environment. Today South Korea is a developed nation and North Korea a developing nation. Since genetic factors are same, obviously environmental factors contributed to development. In other words, democracy, better education, land reforms, free market economy, meritocracy, corruption reduction and better use of foreign aid made South Korea developed nation despite scarce resources. All other developing nation can follow the suit.

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Work and development:

Hard work:

What nation would you consider as the hardest working in the world and why?

South Korea. They don’t mind working even for 24hrs a day. They have turned from an under developed into a completely developed nation within 30 years. Having almost no natural resources and suffering from overpopulation in its small territory, it deterred continued population growth and adapted an export-oriented economic strategy to fuel its economy, and in 2012, South Korea was the seventh largest exporter and seventh largest importer in the world. A look at the average annual hours worked per person in selected countries puts South Korea top with a whopping 2,193 hours, followed by Chile on 2,068.  British workers clock up 1,647 hours and Germans 1,408 – putting them at the bottom of the table, above only the Netherlands.

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Why Germans work fewer hours but produce more?

Working Hours mean Working Hours:

In German business culture, when an employee is at work, they should not be doing anything other than their work. Facebook, office gossip with co-workers, trolling Reddit for hours, and pulling up a fake spreadsheet when your boss walks by are socially unacceptable behaviors. Obviously, in the United States these behaviors are frowned up on by management. But in Germany, there is zero tolerance among peers for such frivolous activities. In the BBC documentary “Make Me A German“, a young German woman explained her culture shock while on a working exchange to the UK. “I was in England for an exchange… I was in the office and the people are talking all the time about their private things… What’s the plan for tonight?, and all the time drinking coffee; She was quite surprised by the casual nature of British workers. Upon further discussion, the Germans reveal that Facebook is not allowed in the office whatsoever, and no private email is permitted.

Goal-Oriented, Direct Communication is valued:

German business culture is one of intense focus and direct communication. While Americans tend to value small talk and maintaining an upbeat atmosphere, Germans rarely beat around the bush. German workers will directly speak to a manager about performance reviews, launch into a business meeting without any ‘icebreakers’, and use commanding language without softening the directives with polite phrases. Whereas an American would say, “It would be great if you could get this to me by 3pm,” a German would say, “I need this by 3pm”. When a German is at work, they are focused and diligent, which in turn leads to higher productivity in a shorter period of time.

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Work enhances human development by providing incomes and livelihoods, by reducing poverty, and by strengthening equitable growth. It also allows people to participate fully in society while affording them a sense of dignity and worth. And work that involves caring for others builds social cohesion and strengthens bonds within families and communities. Human beings working together not only increase material well-being, they also accumulate a wide body of knowledge that is the basis for cultures and civilizations. And when all this work is environmentally friendly, the benefits extend across generations. Ultimately, work can unleash human potential, human creativity and the human spirit. However some work, such as forced labour, can damage human development by violating human rights, shattering human dignity, and sacrificing freedom and autonomy. And without proper policies, work’s unequal opportunities and rewards can be divisive, perpetuating inequities in society. The fast changing world of work, driven by globalization of work and the digital revolution, presents opportunities, but at the same time poses risks. The benefits of this evolving new world of work are not equally distributed and there are winners and losers. Addressing imbalances in paid and unpaid work will be a challenge, particularly for women, who are disadvantaged on both fronts. Creating work opportunities for both present and future generations would require moving towards sustainable work. Work can enhance human development when policies expand productive, remunerative, satisfying and quality work opportunities—enhance workers’ skills and potential—ensure their rights, safety, and well-being—and specific strategies are targeted to particular issues and groups of people.

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Does money makes you happy?

Money doesn’t make you happy. Up to about US$75,000 a year it does – and most people aren’t anywhere near that level – but beyond that it doesn’t have any effect, according to Nobel prize-winning psychologist Daniel Kahneman. In my view, when basic needs like clean water, food, sanitation, housing, clothes, medicine, education, electricity, transport and internet are met anywhere, you should be happy.

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The moral of the story:

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1. Economic development is a measure of a country’s wealth and how it is generated while human development measures the access the population has to wealth, jobs, education, nutrition, health, leisure and safety, as well as political and cultural freedom.

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2. GDP/GNP/GNI per capita and its rate of growth are the best available indicators to provide estimates of the level of economic well-being within a country and of its economic growth. GDP growth can be understated due to non-market/ non-monetary transactions and underground economy.  You can have GDP growth without meaningful change for the majority of its citizens, without change in poverty level or income inequality.

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3. Human Development Index (HDI) is a composite index measuring average achievement in three basic dimensions of human development—a long and healthy life, knowledge and a decent standard of living but it does not reflect on inequalities (income and gender inequality), poverty, unemployment and human security. HDI ranges from a theoretical minimum of zero (for a life expectancy = 25 years, complete illiteracy and a GDP per capita = $100 at purchasing power parity) to a theoretical maximum of one (for a life expectancy = 85 years, 100% literacy and a GDP per capita = $40,000 at purchasing power parity).  Countries with “high” to “very high” human development account for slightly less than a third of the world’s total population (30%). In other words, two third of world population has low to medium human development.

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4. Barring few exceptions, electricity consumption correlate well with development of a nation, and neither HDI nor  GDP of developing countries will increase without an increase in electricity use.

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5. There is a very strong correlation between GDP per capita and HDI. This is because nations today are capable in converting the available national income (measured as GDP per capita) into a longer lifespan for the people and into access to education. This is because with high GDP, the government and the people have more money to spend on education and health care. The converse is also true. The nations today are also very good at converting improved health and education into economic growth. This is because healthier people are more likely to work and as they have better education they are more likely to further themselves in their field earning more money. If you want better health and education fix economic growth. If you want faster economic growth provide better education and health service. Despite plethora of criticism and limitation, despite advent of new indices and barring few exceptions, GDP per capita is still the best index of development of a nation.

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6. My Classification of nations as per development status:

HDI GNI PPP per capita in US$ Development status
>0.85 >12000 Developed nations
0.75 to 0.85 4000 to 12000 Nations in transition
0.5 to 0.75 1000 to 4000 Developing nations
<0.5 < 1000 Least developed nations

In event of inconsistency between HDI and GNI per capita for developmental status, please go by HDI because HDI includes health and education besides GNI per capita. In other words, if GNI per capita puts nation in higher development status compared to HDI, it means more industrial development without concomitant improvement in health and education. The classical example is India whose GNI PPP per capita is 5497 US$ making it  a nation in transition but HDI 0.609 making it a developing nation. Remember, mainstream economics is inadequate in understanding developing nations as compared to developed nations. The implication of the terms “developed” and “developing” is that developing countries will attain developed status as some point in the future. The priority of developing nation is economic growth while the priority of developed nation is economic security.

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7. GDP per capita correlates well with standard of living. High income (developed) countries have higher standard of living as compared to middle income (developing) and low income (least developed) countries.

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8. People in high income countries, on average, live 20 more years than people in low income countries.

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9. One striking feature of developing countries is that agriculture accounts for a large part of GDP and employment.

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10. The relationship between the level of urbanization and per-capita income shows a strong positive relationship. Higher the per-capita, larger is the level of urbanization. Only 41 percent of population live in urban areas in less developed countries, while the share of urban population is 77 percent in more developed countries.

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11. Rule of law is mostly obeyed in developed nations and less commonly obeyed in developing nations who need it most.

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12. Only 78 percent of children (5-14 years) in low income countries go to school and the children who go school receive lower quality of education. 98% of illiterates live in developing countries.

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13. Western developed nations had high literacy rate even in the year 1800 and even that time GDP per capita was higher in them compared to developing nations. Education is the single-most important driver of economic empowerment for individuals and countries. Learning ability to master new technologies and tasks lies at the heart of the growth process. Each additional year of education raises earnings in an individual by approximately 8%. No country has ever achieved rapid and continuous economic growth without at least a 40% literacy rate. Education leads to improved social, cognitive and health outcomes. Education also reduces fertility rate and control population overgrowth. Education is worth improving even if people are struggling to survive. Investment in human capital i.e. education and skills training, is three times as important to economic growth over the long run as investment in physical capital, such as machinery and equipment.  A country that focuses on promoting strong literacy skills widely throughout its population will be more successful in fostering growth and wellbeing than one in which the gap between high-skill and low-skill groups is large.

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14. Resource crunch is portrayed as biggest obstacle to development but worst development outcomes–measured in poverty, inequality, unemployment and violent conflicts–are often found in those countries with the greatest natural resource endowments especially oil-rich middle east. This is because they lack democracy and they have education polluted with religion resulting in poor human capital.

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15. Despite very limited natural resources, Japan has become developed nation due to skilled, hardworking and healthy labour force and advent of new methods to utilize limited resources efficiently. On the other hand, despite abundant natural resources, India remained developing nation due to lazy, unskilled and unhealthy labour force and inefficient utility of natural resources. Inefficiently managed resource is the hallmark of poor nations. Although natural resources are a necessary condition for economic growth, high standard of human capital can overcome scarcity of natural resources. Poor standard of human capital is a drawback uncorrected by any amount of natural resources.  No nation can develop in spites of its natural endowment if such nation does not take seriously human capital development which could be derived through sound academic foundation that is tailored towards a good cradle of nursery, primary and secondary school.

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16. Developing countries like India and China are growing much faster than developed nations. This is because developed nations are in post-industrial service sector economy while developing nations are in the process of industrialization. But the gap between developed and developing nations has widened despite many developing nations growing faster than developed nations, not only because of large initial gap between the income levels of the developed and the developing countries but also because of population explosion in developing nations which reduces GDP per capita substantially.

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17. Development of a nation is a human enterprise and its outcome will depend finally on the skill, quality and attitudes of the men who undertake. Population can help development of nation only if people are educated, skilled, healthy, hard-working, employed and having progressive culture; otherwise they will drain away resources for development and hamper development of a nation.

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18. Populations with higher GDP per capita are observed to have fewer children, even though a richer population can support more children; so economic development will reduce fertility rate and thereby control population explosion. In other words, if you want to control population explosion in a developing nation, besides educating women, go for higher economic growth.

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19. Education is the single most important factor promoting development of a nation and population explosion is the single most important factor hampering development of a nation. Since India has poor quality of education with 74 % literacy rate and population explosion, it is unlikely to become a developed nation in foreseeable future.

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20. Slavery, exploitation and resource extraction due to colonisation are responsible for economic development of many European nations and responsible to make many nations of Asia, Africa and Latin America poor; although geographical bad luck, wrong policies and unproductive culture equally contributed in keeping poor nations poor after their independence from colonial rulers.

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21. Corruption is rampant in developing countries at various levels and it harms poor people more than others, stifles economic growth and diverts desperately needed funds from education, healthcare and other public services.

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22. Wars and civil wars severely hamper development of a nation. Developing nations are hit hard due to military spending as it takes away resources from developmental work. Ironically poor nations spend higher percentage of GDP on military than rich nations. India and Pakistan have fought many wars and spent enormous amount money over Kashmir hindering development of these nations. Developing countries have to learn from developed nations how to solve territorial dispute and rights of self-determination. How Canada handles question of Quebec and how UK handles questions of Scotland and Northern Ireland, democratically and peacefully, is to be learned by developing nations.

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23. Foreign debts of developing nations undermine development because of reduced spending on infrastructure, healthcare, and education.

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24. Every developing country needs its economic policy based on its causes of underdevelopment rather than blindly following economic policies of developed nations.

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25. Barring few exceptions like South Korea and Singapore, foreign aid has not been effective at reducing poverty as it was utilized in unproductive projects, propping up over-valued currencies and enriching corrupt officials; and aid operates as a tool for rich countries to extract wealth, resources, and political compliance. Direct cash transfer to poor families in developing nations is proven to reduce poverty, hunger and inequality.

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26. Trade is the exchange of goods and services between countries and an essential tool for development. However, unfair subsidies, unfair tariff barriers, unfair patent protection and exploitation of cheap labour and environment hamper development of nations.

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27. There are two classic economic maladies of developing nations. First, although welfare program provides much-needed food, medical care and money to poor by redistributing wealth across the population, welfare programs destroy incentives for the poor to work. Second, people are reluctant to work because pay is not linked to work for everybody. India is a classic example of these two economic maladies. As a doctor working in government hospital catering poor people, my experience tells me that free medical treatment to poor people make them not work. Once poor people know that free medical treatment is available, there is no incentive to work as survival is ensured by free government hospital. Also, I know many government doctors who hardly work because they get monthly salary irrespective of their work. What I am telling is the tip of the iceberg and when these two maladies are multiplied in all segments of Indian society, you know why India will remain a developing nation.

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28. Although income inequality drags down GDP growth, a widening gap between the wealthy and the rest of society may foster growth by encouraging many people to work hard, but in India I find the opposite. The wealthy is taxed heavily to finance welfare scheme so that the poor need not work. Instead, the tax from the wealthy should be invested to generate employment for the poor.

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29. The Index of Economic Freedom is based on a composite of ten crude, mostly quantitative indicators: tariff rates, taxation, government’s share of output, inflation (a proxy for monetary policy), limits on foreign investment, banking restrictions, wage and price controls, property rights, general business regulation, and the extent of the black market. Those countries with the most economic freedom have higher rates of economic development than those with less economic freedom. However, economic freedom is more often the result than the cause of development.

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30. Brain drain from developing to developed countries occur because of better standards of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in the developed countries.  It has been estimated that foreign scientists from developing countries involved in research and development produce 4.5 times more publications and 10 times more patents than their counterparts at home. In other words, productive capacity of intellectuals and talented people is far less in developing nations. I always felt that had I been brought up in a developed nation, I would have contributed much more to the world.  The recent literature shows that high-skill emigrations need not deplete a country’s human capital stock and remittances from expatriates living abroad constitute a significant proportion of foreign revenue for many developing countries. Remittances to India stood at $70.39 billion in 2014, accounts for over 4% of the country’s GDP.

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31. Developed countries have become developed by burning fossil fuels causing global warming and now they want developing countries to cut down their emission to reduce global warming. Even today, the U.S. consumes 9 times as much oil per capita as China, and 24 times as much as India, and it wants China and India to cut down their CO2 emission. The truth is every country wants economic development and blame other countries for climate change.

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32. Countries with very low HDI are unlikely to commit the resources for reducing emissions even with economic incentives because they are less environmentally conscious. In other words, economic aid should be given to improve HDI of least developed nations so that higher HDI would make them environmentally conscious to reduce emissions.

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33. All countries ought to incorporate sustainable development in their development policies by controlling overpopulation of the poor & overconsumption by the rich, by the use of environmentally friendly technologies, and by correcting gross inequalities. GDP does not measure the sustainability of growth. A country may achieve a temporarily high GDP by over-exploiting natural resources or by misallocating investment.

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34. In gene vs. environment debate vis-à-vis development of a nation, Korean model proves that environmental factors contribute to development of a nation and not genetic factors.

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35.  Children of developing nations fight many debilitating diseases and so miss a lot of school, have access to poor education & poor diet, and stressful life (e.g. electricity shortage) which could reduce their intelligence. So low GDP per capita can lower average IQ of a nation. As GDP per capita rises with better standard of living, better health and better education, average IQ of a nation increases. Oil-rich Middle East is exception where they have high GDP per capita due to high petroleum resources but lower average IQ. They have not been able to translate high GDP per capita into better education due to lack of democracy and education polluted with religion. Conversely, whether high average IQ of a nation by itself increases GDP per capita is debatable.

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36. All countries must utilize science and technology for solving socio-economic issues. Greater the utility of science and technology, greater the development of a nation.

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37. Democracy, good governance, science and technology, empowerment, overpopulation control, gender equality, better education, better healthcare, land reforms, free market economy, well-developed entrepreneurial class , saving and investment, meritocracy, corruption elimination, hardworking people, curtailment of military expenditure and better use of foreign aid can make any developing nation developed despite limited resources.

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Dr. Rajiv Desai. MD.

January 5, 2016

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Postscript:

I was thrown out from developed nation into developing nation by politicians for the reasons best known to them although standard of living is much higher in a developed nation than a developing nation. In my view, India will not become a developed nation for 100 years. What India needs is better parenting and better education. What India needs is population control, meritocracy, zero corruption, no reservation and hard work. What India needs is to make poor people work and make pay linked to work for everybody.

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EXERCISE

November 19th, 2015

EXERCISE:

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Prologue:

The big four “proximate” causes of preventable ill-health are: smoking, poor nutrition, lack of physical activity and alcohol excess. Of these, the importance of regular exercise is the least well-known. However, exercise is not a new concept. In 300 BC, Aristotle suggested that “a man falls into ill health as a result of not caring for exercise.”  These factors (smoking, nutrition, lack of physical activity and alcohol) are often described as lifestyle choices, yet many people do not have the finances, self-efficacy, environment or knowledge to be able to practice lifestyle choices correctly. We have moved towards a sedentary society with changing work and domestic habits & patterns. We now drive cars, sit in front of computers or TVs and use domestic appliances. There are far fewer manual jobs. This means that physical activity is not routine for most people. In 1949, 34% of miles travelled using mechanical modes were by bicycle; today only 1-2% are. Now half of all adults spend more than 5 hours sedentary every day. Being active has enormous health and well-being benefits. Physical activity is important in the management of long-term diseases, but it is even more important in the prevention of many other common diseases. Over 50% of adults do not reach the minimum recommended level of 30 minutes of moderate intensity exercise five times per week. The exercise should be moderate enough to get a person slightly out of breath and/or sweaty, and with an increased heart rate. Those achieving even this minimum level of activity can reduce their risk of developing heart disease, stroke, dementia, diabetes and some cancers by at least 30%. This is better than many drugs. The need to encourage individuals to participate in physical activity has never been greater. A society-wide increase in moderate physical activity could help reduce health inequalities and improve physical as well as mental health. There are greater intangible costs too, to individuals, families and communities. I have already discussed nicotine addiction, alcohol and food in my earlier articles and exercise was also discussed briefly in my articles on obesity, yoga and diabetes. Today I dedicate full article on exercise.

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Note:

Exercise means physical exercise in this article. Physical fitness means health related physical fitness in this article. It is beyond the scope of this article to discuss in detail specific exercise to prevent or treat specific illness. It is also beyond the scope of this article to discuss sports. All I discuss is utility of exercise to common man and scientific basis of exercise.

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Better to hunt in fields, for health unbought,

Than fee the doctor for a nauseous draught,

The wise, for cure, on exercise depend;

God never made his work for man to mend.

John Dryden

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Life is like riding a bicycle—in order to keep your balance, you must keep moving.

Albert Einstein

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History of exercise:

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Prehistoric period:

Hominids—human beings and their immediate ancestors—have existed on Earth for at least 2,000,000 years. For more than 99 percent of that time, hominids lived a nomadic existence and survived by hunting and gathering food. It is obvious that this way of life was enormously different from the way people live today in developed countries. Thus, evolutionary history has prepared humankind for one kind of life, but modern people lead another. This fact has profound implications for patterns of disease and for the association between living habits and health. Observation of the few remaining nomadic groups in the world indicates that they are relatively free of chronic diseases and that, in comparison to the populations in developed countries, they are leaner, have a higher level of physical fitness, eat a very different diet, and have different physical activity patterns. Data from the distant past are not available, but it is reasonable to speculate that early humans had considerably higher caloric expenditures per unit of body weight than do modern individuals.

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The exercise prescription for health and disease prevention has roots that began in antiquity more than two millennia ago. According to medical historians such as Gordon and Lyons and Petrucelli, breathing exercises, regarded as medical gymnastics, were being practiced in China as early as 2600 BCE. During the era of the Yellow Emperor (1050–256 BCE), these exercises were used for subjects experiencing chills, fevers, or complete paralysis. In addition, massage with exercise of the extremities was also being recommended. During this same time period, the yin-yang doctrine was prevalent, with yang being identified with life and health, whereas disease and death were associated with yin. Susruta of India was the first “recorded” physician to prescribe moderate daily exercise, Hippocrates of Greece was the first “recorded” physician to provide a written exercise prescription for a patient suffering from consumption, and Galen from Rome recommended the use of exercise for patients in the management of disease. Susruta was the first recorded physician to prescribe exercise for his patients and to indicate that “it should be taken every day” but taken “only to half extent of his capacity” as otherwise “it may prove fatal”. In addition, before prescribing exercise, it was essential for the physician to consider the age, strength, physique, exercise terrain, and diet of the patient. Susruta advocated exercise because it made the body stout, strong, firm, compact, and light, enhanced the growth of limbs and muscles, improved digestion and complexion, prevented laziness, and reduced senility  while being “absolutely conducive to a better preservation of health”.  Hippocrates (460–370 BCE) wrote that “eating alone will not keep a man well, he must also take exercise”. Hippocrates also stated that “. . . food and exercise, while possessing opposite qualities, yet work together to produce health”. Although Hippocrates was not the first physician to prescribe exercise for patients, he was the first recorded physician to provide a written exercise prescription for a patient suffering from consumption. Specifically, in Diseases III and internal affections, Hippocrates provided a detailed written exercise prescription of walking for a patient with consumption. To Galen, work and exercise were equivalent terms, whereas motion had to be vigorous and cause labored breathing if it was to be designated as exercise. He classified exercise as being slow, swift, atony, vigorous, gentle, and violent; select examples are as follows: running was swift, lifting a heavy weight was vigorous, and continuous jumping was violent. However, if exercise was to be prescribed for health reasons, it was to be moderate. Of the exercises being mentioned, Galen’s favourite exercise comprised games in which a small ball was used. Historically intertwined with these concepts was exercise being advocated by select physicians to minimize the health problems associated with obesity, diabetes, and inactivity. Hippocrates wrote the following: “All parts of the body, if used in moderation and exercised in labors to which each is accustomed, become thereby healthy and well developed and age slowly; but if they are unused and left idle, they become liable to disease, defective in growth and age quickly.”  With the decline of the Hellenic civilization, this concept faded. For centuries, physical activity and fitness were considered largely for military purposes and associated with youth sports and athletics even through the post–World War II era.

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Movement or locomotion is perhaps the most meaningful behavior animals engage in. Humans are no exception, and approximately 2 million years ago evolved an ability to run sustained long distances. Independent of the necessity to procure food or find reproductive partners, it has been well documented that humans and mammals frequently engage in play behavior, or specifically within human populations – leisure time activity or “sport.” The need for or social implications of play behavior are beyond the scope of this article. A more relevant aspect is the importance of play behavior in facilitating exercise training, which may allow individuals to acclimatize to physical activity. Regardless of the specific benefits of physical activity or exercise, organized sport has perhaps always had a place in human society. Although the relative importance of sport or leisure physical activity and its perceived impact on the body has fluctuated over time, exercise, and specifically jogging, became a cultural phenomenon in the late 1960s and 1970s. This sensation was initiated and perpetuated by promotion of the health benefits of physical activity programs accessible to all ages, and marketing and profits related to promotion of sport. In addition to running, over the past four decades enormous volumes of heath-centered programs (both psychological and physiological) based on a variety of activities have seen gains in popularity. Ironically, as insights into the benefits of regular physical activity have increased dramatically since inception of the jogging revolution, total physical activity has been on a global downward trend since 1965. Today many people remain largely inactive; some are only irregularly active, whereas others do engage in enough activity to realize the health benefits.

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Exercise in animals:

Physical exercise has been shown to benefit a wide range of other mammals, as well as salmon, juvenile crocodiles, and at least one species of bird. However, several studies have shown that lizards display no benefit from exercise, leading them to be termed “metabolically inflexible”.  Regular exercise is important to avoid illness and encourage normal behaviour patterns in most pet animals. If you accept the responsibility of keeping a pet you must appreciate that, for most animals, regular exercise is very important for their well-being. To deny an animal the space and opportunity it needs to exercise can result in abnormal behavioural patterns as well as ill health. Reptiles and insects are a few of the species which prefer confined spaces and do not take the opportunity to exercise if allowed to do so.

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Typical examples of pets being deprived of exercise are:

•cats kept in flats – where there is simply no opportunity for them to exercise properly

•dog owners who work all day and play at nights and weekends – without building an exercise period for their dog into their daily routine

•rabbits and guinea pigs that are kept confined to a cage or hutch all year round without access to an exercise run

•hamsters that are kept in a small cage and not provided with a wheel or an exercise ball, and

•birds without enough flight space in their cage.

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Studies in humans have clearly shown the psychological and physical benefits of regular exercise, resulting in an improved quality of life, reduced susceptibility to illness and increased life-span.  Exercise is important as it allows our pets to express their normal instinctive behavioural traits including inquisitive exploration, the use of scent, sight and hearing, tracking, stalking, play-fighting, play-defensive behaviour, hiding, attacking, chasing, greeting members of the same species, dealing with strange objects and dealing with animals from different species. Exercise also encourages the development of a normal daily toilet routine. Cats and dogs deprived of regular exercise and confined to the home may develop anti-social behaviour patterns including destructive behaviour, aggressive territorial guarding, house soiling and vocalisation when left alone without human companionship.  A degree of exercise (but not excessive exercise) is needed for normal muscular and skeletal development in young, growing animals. Animals deprived of exercise will develop poor muscle conformation (due to muscle atrophy) and a sedentary life-style which will predispose them to develop obesity and other disorders. The most common adverse effect of insufficient exercise is obesity and all pets can develop this if they are fed too many calories. Millions of pet dogs, cats, rabbits, guinea pigs, hamsters, rats, ponies and birds (which are “loved” by their owners) are obese simply because owners do not control calorie intake and provide insufficient exercise, or because they have encouraged or enforced the development of a sedentary lifestyle. Obesity has all sorts of negative effects on the body – and it can make various diseases worse (e.g. heart disease, orthopaedic disease, skin disease). Obesity also plays an important role in the cause of some common diseases – including diabetes mellitus.

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Physical inactivity reduced life span of elephant by third:

Elephants born and raised in zoos live less than half as long as those living in their native Africa and Asia, despite being protected from predators and having better care, according to one of the reports. Many of the deaths are thought to be linked to obesity, because the animals are well fed but get very little exercise in their small enclosures. Scientists also blamed high stress levels, which the animals suffer most after being transferred between zoos and being separated from their mothers.  Scientists called on zoos to introduce immediate health checks on elephants to identify obese and stressed animals. In one study, researchers led by Ros Clubb, a wildlife scientific officer at the Royal Society for the Prevention of Cruelty to Animals, analysed records of 786 Asian and African female elephants kept in European zoos between 1960 and 2005. They then compared the lifespans of the captive animals with Asian elephants used by a logging company in Burma, and African elephants living in the Amboseli national park in Kenya. Asian elephants born in captivity typically lived for 18.9 years, while those used as working animals in Burma survived for 41.7 years. African elephants also fared worse, living for 16.9 years in captivity and 35.9 years in the wild. When the scientists discounted African elephants killed by people in the national park, the typical lifespan reached 56 years, more than three times as long as those kept in zoos. “You would expect captive elephants to live at least as long, if not longer, than those in the wild because they are better cared for, but that is not the case. The difference is massive,” said Clubb, whose study appears in the US journal Science. A second report, commissioned by the Department for Environment, Food and Rural Affairs, examined the welfare of 77 elephants in 13 UK zoos. It found that the animals spent 83% of their time indoors and 71 were overweight. Only 11 were able to walk normally. “We often hear that zoos play a vital role in conserving elephants but patently this is not the case,” said Rob Atkinson, head of wildlife science at the RSPCA.  “The new data shows elephants die young in Europe’s zoos, and those Asian elephants born in captivity have a poor chance of survival. Surely the way forward is to encourage conservation programmes in native habitats rather than condemn elephants to a shortened and unhealthy existence in our zoos.” He added: “Elephants are having a torrid time in our zoos, judging by this overwhelming evidence, and action must be taken to alleviate their welfare problems as a matter of urgency.”  Zoo enclosures for elephants are typically 60 to 100 times smaller than the smallest wild territories. African elephants can roam over 2,000 square miles, and Asian elephants 300 square miles. In captivity, researchers said, elephants are also at risk from infanticide, tuberculosis, herpes and lameness.

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Introduction to exercise:

Physical exercise is any bodily activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons, including strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, and merely enjoyment. Frequent and regular physical exercise boosts the immune system and helps prevent the “diseases of affluence” such as cardiovascular disease, Type 2 diabetes, and obesity. It may also help prevent depression, help to promote or maintain positive self-esteem, improve mental health generally, and can augment an individual’s sex appeal or body image, which has been found to be linked with higher levels of self-esteem. To enjoy a long and healthy life, everyone should make lifestyle choices that include a healthy diet, regular exercise, and maintaining normal weight. The combination of inactivity and eating the wrong foods is the second most common preventable cause of death in the United States (smoking is the first). Most research on the benefits of exercise focuses on heart protection. Studies clearly show that exercise helps the heart. In addition, studies are reporting that even people with heart disease may gain important benefits from exercising, though they need medical clearance and special precautions. Childhood obesity is a growing global concern, and physical exercise may help decrease some of the effects of childhood and adult obesity. Health care providers often call exercise the “miracle” or “wonder” drug—alluding to the wide variety of proven benefits that it can provide.

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Appropriate exercise improves muscular strength and endurance, body composition, flexibility, and cardiorespiratory endurance. The level of maximal oxygen intake or cardiorespiratory endurance is not by itself of great importance to most individuals. What is important is that one’s sustained energy-spending ability is directly related to maximal levels of performance. For example, consider the simple task of walking at a rate of three miles per hour. This task involves an energy expenditure of approximately three times the resting metabolic rate. Extremely unfit individuals may have a maximal aerobic power of only six times their resting metabolic rate. For such individuals, a three-mile-per-hour walk requires half of their maximal capacity. A middle-aged person who exercises regularly will have a maximal aerobic power 10 to 12 times resting, so the same walk will represent only 25 to 30 percent of maximal capacity. This example illustrates how any submaximal task is relatively much easier for the conditioned individual. Moreover, a person cannot work throughout the day at much more than about 20 percent of maximal capacity without becoming chronically fatigued. The deconditioned person who has a maximal aerobic power of six times resting can comfortably sustain a work level of only about 1.2 times resting throughout the day (6 × 0.20 = 1.2). This low capability for sustained energy expenditure can support only a very sedentary existence: for example, 20 hours of sleep and rest, two hours of personal care, one hour of housework and shopping, and one hour of activity at three times the resting rate each day. The point of the preceding discussion is that the average energy-expenditure requirement of anyone’s life can be calculated, and a person’s maximal cardiorespiratory endurance determines how active a life-style can be sustained. Individuals who attempt to lead more active lives than their fitness level will support become chronically fatigued. Persons with adequate or optimal fitness levels, on the other hand, are able to meet the physical demands of an active life relatively easily. One of the most frequent observations made by individuals who have begun an exercise program is that they feel better, and research studies document an improvement in feelings of general well-being in more active people.

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The health benefits of regular participation in sports and aerobic fitness have been well recognized for more than 30 years. However, over the past decade new scientific evidence has shown that physical activity need not be strenuous to be beneficial to health. In fact, 30 minutes of moderate-intensity physical activity every day or on most days of the week provides important health benefits. This modest but regular amount of activity can greatly reduce or prevent the risk of cardiovascular disease, type 2 diabetes, osteoporosis, colon cancer, and breast cancer. Regular, moderate physical activity, including daily activities such as climbing stairs, brisk walking, and biking, can reduce stress, alleviate depression and anxiety, enhance self-esteem, and increase mental alertness. Moreover, school-age children who are regularly active demonstrate enhanced school performance and a better sense of personal and social responsibility than those who are more sedentary.

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The benefits of exercise include:

•Decreased risk of cardiovascular (heart) disease, high blood pressure, and stroke

•Decreased risk of colon and breast cancers

•Decreased risk of diabetes

•Decreased risk of osteoporosis

•Decreased risk of depression and dementia

•Decreased body fat

•Improved metabolic processes — the way the body breaks down and builds necessary substances

•Improved movement of joints and muscles

•Improved oxygen delivery throughout the body

•Improved sense of well-being

•Improved strength and endurance

In addition, exercise can help change other dangerous lifestyle habits. A 2007 review of existing studies found that moderate exercise, for as little as 5 minutes at a time, can help combat the nicotine withdrawal symptoms people have when they try to stop smoking. No one is too young or too old to exercise. The United States Surgeon General recommends at least 30 minutes of moderate exercise, such as brisk walking, nearly every day.

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Couch potato:

While the term couch potato usually refers to a lazy person who prefers to just sit around and watch TV, an active couch potato refers to someone who is inactive for the majority of the day, but regularly makes sure to get in 30 minutes of exercise on most days. An active couch potato is not necessarily lazy, but spend most of his or her time sitting during leisure time, work (and commuting to and from work) and while eating meals. In other words, they’re almost completely physically inactive throughout the day, with the exception of that 30 or minutes of daily exercise. Although 30 minutes of exercise is absolutely beneficial and healthful, the rest of the day is causing tremendous health hazards. In fact, the World Health Organization (WHO) has identified physical inactivity as an independent risk factor for chronic disease development, and it is now the fourth leading cause of death worldwide.

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Sedentary lifestyle:

A sedentary lifestyle is a type of lifestyle with no or irregular physical activity. A person who lives a sedentary lifestyle may colloquially be known as a slob or couch potato. It is commonly found in both the developed and developing world. Sedentary activities include sitting, reading, watching television, playing video games, and computer use for much of the day with little or no vigorous physical exercise. A sedentary lifestyle can contribute to many preventable causes of death. Screen time is the amount of time a person spends watching a screen such as a television, computer monitor, or mobile device. Excessive screen time is linked to negative health consequences.

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Sedentary behaviour:

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Myth: You have to be athletic to exercise.

Fact: Most physical activities don’t require any special athletic skills. In fact, many people who have bad memories of difficult school sports have discovered a whole world of enjoyable, healthful activities that involve no special talent or training. A perfect example is brisk walking—a superb, heart healthy activity. Others include bicycling, gardening, or yard work, as long as they’re done at a brisk pace. Just do more of the activities you already like and already know how to do. It’s that simple.

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What are some tips to help me get moving?

•If you can’t set aside one block of time, do short activities throughout the day, such as three 10-minute walks.

•Create opportunities for activity. Try parking your car farther away from where you are headed. If you ride the bus or train, get off one or two stops early and walk.

•Walk or bike to work or to the store.

•Use stairs instead of the elevator or escalator.

•Take breaks at work to stretch or take quick walks, or do something active with co-workers at lunch.

•Walk while you talk, if you’re using a cellphone or cordless phone.

•Doing yard work or household chores counts as physical activity. Turn on some upbeat music to help you do chores faster and speed up your heart rate.

Experts say that for a physically inactive person to become active, and remain active for the long-term, the activity needs to be convenient and enjoyable. The activity needs to be something you can easily fit into your routine for several days each week. Even if you end up adding just 30 minutes of physical activity to your day, that is fine. Some of the examples below are the easiest to fit into a daily routine:

•Go for a brisk 30-minute walk five times each week. Ideally, it should be done in one session. If you can’t, two 15-minute sessions would also be good.

•Walk you dog more often. If you do not have a dog but know a nearby friend who has one, offer to walk it for him/her.

•Find out whether there are any swimming pools nearby. Try to add some swimming to your weekly routine. This does not have to be every day.

•During your lunch break at work go for a walk.

•Join some exercise classes.

•Beginners must remember that the secret is “little and often”. A little bit every day is great – one big session once a week is not. Make sure your progress is gradual.

•Experts say an exercise program should include both aerobic and anaerobic activities. This is true. However, if you are currently inactive, anything is better than nothing.

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Make it fun:

•Choose activities that you enjoy.

•Vary your activities, so you don’t get bored. For instance, use different jogging, walking, or biking paths. Or bike one day, and jog the next.

•Reward yourself when you achieve your weekly goals. For instance, reward yourself by going to a movie.

•If you have children, make time to play with them outside. Set a good example!

•Plan active vacations that will keep you moving, such as taking tours and sightseeing on foot.

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Make it social:

•Join a hiking or running club.

•Go dancing with your partner or friends.

•Turn activities into social occasions — for example, go to a movie after you and a friend work out.

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Overcome challenges:

•Don’t let cold weather keep you on the couch. You can find activities to do in the winter, such as indoor fitness classes or exercising to a workout video.

•If you live in a neighbourhood where it is unsafe to be active outdoors, contact your local recreational center or church to see if they have indoor activity programs that you can join. You can also find ways to be active at home. For instance, you can do push-ups or lift hand weights. If you don’t have hand weights, you can use canned foods or bottles filled with water or sand.

Don’t expect to notice body changes right away. It can take weeks or months before you notice some of the changes from being physically active, such as weight loss. And keep in mind, many benefits of physical activity are happening inside you and you cannot see them.

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Key Points to remember when exercising:

1. Listen to your body.

You must be careful with your exercise as if it is done improperly it may actually worsen your health.  So, if exercise worsens your symptoms, modify your program or, if need be, stop. Because even though your body desperately needs exercise to improve, you will only get worse if you violate your current limitations. So you may have to start with as little as one or two minutes a day, and work your way up from there. As your energy and health improve, you will be able to tolerate larger amounts of exercise, which will lead to weight loss and increased energy.

2. Be consistent.

Research has shown that to lose 10 percent of your body weight, and keep it off, you need to exercise for one hour, five days a week. This level of exercise is only required if you are overweight, as you have an accumulated an exercise debt that must be “repaid” to regain your health.

3. Increase your intensity regularly.

Ideally you should exercise at an intensity that makes it somewhat difficult to talk to the person next to you. This prevents you from having to measure your pulse or use a heart-rate monitor. If you can comfortably talk to the person next to you, you aren’t working hard enough to produce the benefits you need to lose weight. However, if you are breathing so heavily that you cannot carry on a conversation at all, then you are exercising too hard and need to cut back a bit. Using this simple technique as a guide will assure that you’re constantly increasing your intensity as your fitness level increases.

4. Don’t rely solely on cardio.

You will need to incorporate interval-type training, along with strength training to develop a far more rounded and comprehensive exercise program. You may also want to integrate something to promote flexibility and core muscles, such as yoga, which has been proven particularly beneficial if you suffer from back pains.

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A few simple rules are helpful as you develop your own routine.

•Don’t eat for 2 hours before vigorous exercise.

•Drink plenty of fluids before, during, and after a workout.

•Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body’s warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

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Every exercise session should include a warm-up, conditioning phase, and a cooldown:

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and can help prevent soreness or injury, especially in older people. Warming up before exercise and cooling down after is just as important as the exercise itself. By properly warming up the muscles and joints with low-level aerobic movement for 5 – 10 minutes one may avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

• Warm-up. Take it easy for a few minutes as your body gets used to what you’re asking it to do. Perform warm-up exercises for 5 – 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal. In a meta-study of 32 high quality studies, about 4/5ths of the studies showed improvements in performance after warm-up.

• Conditioning. This is the main part of your workout.

• Cool-down. You’re transitioning out of your workout. Don’t sit, standstill, or lie down right after exercise, or you may feel dizzy or lightheaded or have heart palpitations (fluttering in your chest). The best cool-down is to ease up on the intensity of your activity.  To cool down, you should walk slowly until the heart rate is 10 – 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping. Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.

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Shoes:

All that’s really necessary for a workout is a good pair of shoes that are made well and fit well. They should be broken in, but not worn down. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete’s foot.

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Shoes for exercise:
Aerobic dancing Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.
Cycling Rigid support across the arch to distribute pressure during pedalling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.
Running Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.
Tennis Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.
Walking Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.

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Clothing:

Comfort and safety are the key words for workout clothing. For outdoor night-time exercise, a reflective vest and light-coloured clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

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Motivation for exercise:

Physical exercise is an effective approach in health promotion wherein the physical conditioning of those who regularly participate in physical activities increases and/or improves both their physical and psychological capacities. People in technologically developed societies understand the benefits of physical exercise as a healthy behavior, yet they have amongst the highest inactivity rates. This paradox is revealing of a strong, yet poorly characterized mechanism underlying the current lack of motivation and engagement in physical activity. As many as 50% of people who start an exercise program will drop out during the first 6 months. Eight weeks are needed for an initiate exerciser to become a regular exerciser, but even after 6 months, the motivation of initiating exercisers remains significantly lower than long-term regular exercisers. Low levels of motivation and self-efficacy, time-shortage, low familiarity with exercise, and poor social and cultural support are considered the primary reasons why individuals fail to adhere to physical exercise programs after they begin. A study by Brière et al. (2003), found many individuals to believe that exercise will not bring any benefit or that they are not able to perform exercise satisfactorily. This raises questions as to role and durability of existing rational arguments about the benefits of being physically active in changing the behavior of inactive individuals. Motivation factors may differ by gender, and women appear to have a harder time. In one study, weight loss was the greatest motivator to exercise for women, and muscle tone was the primary motivator for men. Unfortunately, effects on appearances may take a long time to show, discouraging people from continuing an exercise program even though their health is improving.

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Motivation, or a lack thereof, is one reason many people stop exercising. Here are some tips for avoiding burnout:

•Think of exercise as a menu rather than a prescription. Choose a number of different physical activities that are personally enjoyable such as sports, dancing, or biking. Although experts say you should get 30 minutes of aerobic exercises at least five times a week, those times can be divided into shorter periods — such as 10 minute sessions. In addition, people can achieve health benefits from other exercise programs, including weight training, yoga, or Tai chi.

•Stick to a prepared schedule and record progress.

•Develop an interest or hobby that requires physical activity.

•Adopt simple routines such as climbing the stairs instead of taking the elevator, walking instead of driving to the local newsstand, or canoeing instead of zooming along in a powerboat.

•Try cross training (alternating between exercise types). Studies suggest it is more beneficial than focusing only on one form of exercise.

•Exercise with friends.

•Join a gym or take classes. Many affordable programs are available.

•For those who can afford them, personal trainers can be very helpful and are available in many gyms and exercise clubs. Personal trainers without any connection to a well-reputed gym or fitness club should be certified by a major fitness organization, such as the Aerobics and Fitness Association of America (AFAA) or the American Council on Exercise.

•Exercise videos may also be helpful, but people should be sure they are suited to their individual age and health needs, and bear the AFAA seal.

•Consider getting a dog. Studies show that dog owners walk up to twice as much as those who do not own a dog. Regular walking is a good way to improve health.

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Finding the time to exercise:

Many people who do not exercise say they do not have the time. However, it is possible to increase the amount of time you are physically active, even if you are extremely busy. For example:

•See how many trips you take by car and decide which ones could be replaced by walking or cycling. Traffic experts throughout most of the world say that the majority of car trips are very short ones.

•If you are using public transport try getting off at an earlier stop and walking the rest of the way.

•A study found that interactive video games – such those played on the Nintendo Wii – may raise heart rate and provide exercise intensity levels high enough to meet federal physical activity guidelines.

•When you are in a building and want to go upstairs, try walking it, rather than taking the elevator or escalator.

•There are several gentle exercises you can do while watching TV. Even short bursts of 30 second exercises are good for improving metabolism, a study found.

•Migraine – there are many safe exercises for migraine sufferers.

•If you do housework, see if you can do it a bit more vigorously and turn it into an exercise session.

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Myth: Physical activity takes too much time.

Fact: Physical activity does take some time, but there are ways to make it manageable. If you don’t have 30 minutes in your daily schedule for an activity break, try to find three 10-minute periods. Fitting regular exercise into your daily schedule may seem difficult at first. But even ten minutes at a time is fine. The key is to find the right exercise for you. It should be fun and should match your abilities. If you’re aiming for 60 minutes daily—a good goal if you’re trying to avoid weight gain—perhaps you can carve out some “fitness time” early in the day, before your schedule gets too busy. Another idea is to combine physical activity with a task that’s already part of your daily routine, such as walking the dog or doing yard chores.

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Time of exercise:

Fitness experts have long said that exercising in the morning can help you stay consistent with your workouts. But there hasn’t been much research to back up that claim — until now. Jawbone crunched the data from more than 1 million people who track their steps and workouts using Jawbone’s fitness tracking products and apps. The results confirm that people who exercise in the morning are more likely to work out consistently (defined as three or more workouts per week). The magic hour for workouts? Six o’clock in the morning, according to the data. About 11 percent of the people who sweat three or more days a week exercised at 6 a.m. — a far greater percentage than any other hour of the day. Five a.m. was the second most popular time for consistent exercisers, followed by 9 a.m. People who were inconsistent with their workouts, in contrast, tended to hit the gym around 6 p.m.

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Safety tips for beginning exercisers:

If you’ve never exercised before, or it’s been a significant amount of time since you’ve attempted any strenuous physical activity, keep in mind the following general health precautions:

• Get medical clearance. If you have special health issues such as an existing heart condition or high blood pressure, talk with your doctor or health practitioner and let him or her know your plans.

• Stretch. No matter what form of exercise you choose, you’ll benefit from adding stretching exercises to gain flexibility and range of motion. Stretching gently to warm up and cool down is the best form of injury-prevention for new exercisers.

• Drink plenty of water. Your body performs best when it’s properly hydrated. Failing to drink enough water when you are exerting yourself over a prolonged period of time, especially in hot conditions, can be dangerous.

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Warnings regarding exercise:

Do not exercise:

•If your blood counts are low and you are at risk for infection, anemia, or bleeding.

•If the electrolytes in your blood, such as sodium and potassium, are not normal (this is likely to be the case if you have been vomiting or having diarrhoea).

•If you are taking treatments that affect your lungs or heart, or are at risk for lung or heart disease. Instead, consult your doctor first, and then watch for swollen ankles, sudden weight gain, or shortness of breath.

•If you have unrelieved pain, nausea, vomiting, or other health concerns. Always consult your doctor before beginning any exercise program.

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Precautions to consider as you exercise:

•Do not overexert your body if you are taking blood pressure medication that controls your heart rate.

•Do not hold your breath, as this may put a strain on your heart.

•Do not exercise on uneven surfaces that could cause you to fall.

•If you have bone disease, poor vision, poor balance, or weakness, do not use heavy weights or perform excessive weight bearing exercises.

•Watch for signs of internal or external bleeding if you are taking antiplatelet or anticoagulant.

•If you have swelling, pain, dizziness, or blurred vision, discontinue all exercise and call your doctor immediately.

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Consult doctor before exercise:

You should always check with your doctor before starting a new exercise program, especially if you have any of the following risk factors:

•A symptom you have never told your doctor about

•Arthritis of the hips or knees

•Blood clots

•Chest pain

•Chronic lung disease

•Diabetes

•Eye injury or recent eye surgery

•Family history of a cardiovascular disease

•Foot or ankle sores that won’t heal

•Heart disease or stroke

•Heart palpitations

•Hernia

•High blood pressure

•History of smoking

•Infections

•Joint swelling

•Obesity

•Pain or trouble walking after a fall

•Shortness of breath

• Injury or disability

• Pregnancy

• Recent hip surgery

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Exercise programs for High-Risk Individuals:

Anyone with heart disease or risk factors for developing heart disease or stroke should seek medical advice before beginning a workout program. Patients with heart disease can nearly always exercise safely as long as they are evaluated beforehand. Some will need to begin their workout under medical supervision. Still, it is often difficult for a doctor to predict health problems that might arise as the result of an exercise program. At-risk individuals should be very aware of any symptoms warning of harmful complications while they exercise.

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Can I stay active if I have a disability?

A disability may make it harder to stay active, but it shouldn’t stop you. In most cases, people with disabilities can improve their flexibility, mobility, and coordination by becoming physically active. Getting regular physical activity can also help you stay independent by preventing illnesses, such as heart disease, that can make caring for yourself more difficult. Even though you have a disability, you should still aim to meet the physical activity goals. Work with a doctor to develop a physical activity plan that works for you.

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Exercise in sickness:

Should you really exercise when your body doesn’t feel 100 percent?

Most clinicians recommend that if your symptoms mirror a common cold without a fever – in other words, the illness remains above the neck – you can exercise moderately by doing activities like walking. The American Council on Exercise supports low-impact physical activity of 30 minutes or less when exercising with a cold.  Exercising while sick may even be beneficial, since working up a sweat causes immune cells to circulate through the body more quickly and better kill bacteria and viruses. In a classic study published in the journal of Medicine & Science in Sports & Exercise, researchers recruited 45 18- to 29-year-olds of various fitness levels who agreed to be infected with rhinovirus, the culprit of most common colds. In two days, when symptoms reached their peak, the participants ran on treadmills at moderate and intense levels. The researchers reported that having a cold had no effect on participants’ lung function or ability to exercise. Researchers also tested the runners at different points in the exercise sessions and found that their colds had no effect on the way their body responded to activity. That said, these findings won’t hold true with symptoms more severe than a common cold. With the flu or a more severe illness, when symptoms maybe include a fever, extreme tiredness, muscle aches or swollen lymph glands, you should rest and postpone intense exercise until at least two weeks after symptoms disappear. If you have doubts or think you may have a more serious illness, talk to your doctor.

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Rest after exercise:

Rest is part of recovery. Recovery is everything that happens after the end of one workout and before the start of the next one. So rest includes sleep, time for stillness—both mental and physical—as well as participation in activities that provide mental and/or physical rejuvenation. The body repairs and strengthens itself in the time between workouts, and continuous training can actually weaken the strongest athletes. Rest days are critical to sports performance for a variety of reasons. Some are physiological and some are psychological. Rest is physically necessary so that the muscles can repair, rebuild and strengthen. For recreational athletes, building in rest days can help maintain a better balance between home, work and fitness goals. Recovery allows the body to replenish energy stores and repair damaged tissues. Exercise or any other physical work causes changes in the body such as muscle tissue breakdown and the depletion of energy stores (muscle glycogen) as well as fluid loss. Recovery time allows these stores to be replenished and allows tissue repair to occur. Without sufficient time to repair and replenish, the body will continue to breakdown from intensive exercise. In the worst-case scenario, too few rest and recovery days can lead to overtraining syndrome – a difficult condition to recover from. Symptoms of overtraining often occur from a lack of recovery time. Signs of overtraining include a feeling of general malaise, staleness, depression, decreased sports performance and increased risk of injury, among others.

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Rest days are an essential part of an exercise program. Your body needs about 48 hours to recover between exercises targeting the same muscle group. You can still exercise every day, just not the same muscle. Youth baseball pitchers need at least 24 hours rest after a game. Some runners rest once a week. Everyone is different. Rest needed depends on many factors including your age, activity, and nutrition, but everyone needs some. If you work out intensely but don’t allow for down time, your body will be less apt to reap the benefits. Exercise puts stress on the body, including the joints, which don’t have much padding for projection from injury. The knee, ankle and hip joints take a particular beating with respect to the repetitive nature of running. Without regular rest breaks, they may become sore and swollen. A much needed rest between bouts of exercise will help avoid this problem and keep your joints healthy. An appropriately challenging workout will, in general, require one to two recovery days.

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Nutrition and exercise:

Proper nutrition is at least as important to health as exercise. When exercising, it becomes even more important to have good diet to ensure the body has the correct ratio of macronutrients whilst providing ample micronutrients, in order to aid the body with the recovery process following strenuous exercise. You can help your body to exercise better by eating the right foods. You know that muscle metabolism involves the phosphagen system, glycogen-lactic acid system and aerobic respiration. The major fuels used are glucose and glycogen. So, if you want to do well, whether you are competing or just exercising for well-being, you should try to increase the stores of glycogen in your liver and your muscles. Athletes eat solid, high-carbohydrate diets (breads, pasta) the night before competition, and liquid, high-glucose diets in the morning before competition. Sports drinks containing glucose are good to drink during competition to replace fluid and help to maintain blood glucose levels.

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Vitamins and exercise:

Although no conclusive evidence exists to suggest that vitamin supplementation improves athletic performance in nutritionally adequate individuals, exercise may increase requirements for certain vitamins in individuals with marginal vitamin stores. Exercise increased the requirement for riboflavin and vitamin C; however, vitamin supplementation improved the ability to train only in vitamin C-depleted individuals. No measurable effect of supplemental thiamine, riboflavin, or vitamin B6 on performance was observed in any of the reported studies. Exercise acutely affected vitamin B6 metabolism. Confusion regarding vitamin supplementation and exercise performance may stem from a lack of adequate research data.

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Adaptation to Exercise:

The Principle of Adaptation states that when we undergo the stress of physical exercise, our body adapts and becomes more efficient. It’s just like learning any new skill; at first it’s difficult, but over time it becomes second-nature. Once you adapt to a given stress, you require additional stress to continue to make progress. There are limits to how much stress the body can tolerate before it breaks down and risks injury. Doing too much work too quickly will result in injury or muscle damage, but doing too little, too slowly will not result in any improvement. This is why personal trainers set up specific training programs that increase time and intensity at a planned rate and allow rest days throughout the program.

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Exercise statistics and trends:

Most of the health benefits of exercise have been widely publicized and to some extent enjoy popular recognition. Nevertheless, sedentary lifestyles are predominant in most urban areas worldwide. Indeed, inactivity constitutes an important risk factor behind the epidemic rates of non-communicable diseases (NCDs). In its 2002 World Health Report the World Health Organization (WHO) reported that 76% of all deaths in the Americas in the year 2000 were due to NCDs, a proportion similar to that found in the developed regions of Europe (86%) and the Western Pacific (75%). In that same year in Latin America alone there were an estimated 119 000 deaths due to inactive lifestyles.

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Latin America and the Caribbean have become the most urbanized region in the developing world, with over 60% of the population residing in urban centers. This rapid urban population growth has outpaced the development of social and physical infrastructure, employment, health services, and housing. Together, these various trends have contributed to inadequate public transportation systems, increased traffic congestion and environmental pollution, decreased activity levels in both work and leisure time, and changes to the physical and social urban landscape. Data from 24 countries in the Region of the Americas indicate that over half the population are inactive, that is, not performing the minimum recommended 30 minutes of moderate-intensity activity on at least 5 days of the week. In several of the countries of the Americas the proportion of the population at risk due to inactive lifestyles is close to 60%. This situation may be especially critical among persons 60 and older. These persons make up the fastest growing segment of the population in Latin America and the Caribbean, with a growth rate that is 3.5 times that of the population overall. In addition, these older persons have the highest prevalence of NCDs. For this large and growing population with decreased mobility and other health concerns, environments that support a physically active lifestyle and greater access to public transportation are becoming increasingly important.

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The figure below shows finding of exercise survey conducted by CDC in the U.S.

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The American Heart Association recommends 150 minutes of moderate intensity aerobic exercise per week for most adults, yet according to the Center for Disease Control and Prevention, only 1 in 5 adults meets these overall physical activity guidelines. The estimated economic burden of physical inactivity in the United States in 2005 was $24 billion, which accounted for 2.4% of total health expenditures. Strategies to promote recruitment and retention in an exercise program have been met with limited success. In 2007, the American College of Sports Medicine, with endorsement from the American Medical Association and the Office of the Surgeon General, launched a global initiative to mobilize physicians, healthcare professionals and providers, and educators to promote exercise in their practice or activities to prevent, reduce, manage, or treat diseases that impact health and the quality of life in humans. Emerging from this initiative, termed ‘Exercise is Medicine’, has been an extensively documented position stand by the American College of Sports Medicine that recommended healthy adults perform 150 min of moderate dynamic exercise per week. Complying with the ACSM-AHA guidelines offers a considerable return on a minimal investment. Yet in spite of the evidence of health benefits and the minimal time investment, almost half of American adults fail to meet these levels of activity.  The numbers are likely similar in Canada. Fifty percent of all people who begin a vigorous training program drop out within a year. The key to reaching and maintaining physical fitness is to find activities that are exciting, challenging, and satisfying.

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Physical activity versus Exercise:

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Some definitions:

Health:

In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental or social challenges.

Physical activity:

Any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal level. Physical activity generally refers to the subset of physical activity that enhances health.

Health-enhancing physical activity:

Activity that, when added to baseline activity, produces health benefits. Brisk walking, jumping rope, dancing, playing tennis or soccer, lifting weights, climbing on playground equipment at recess, and doing yoga are all examples of health-enhancing physical activity.

Exercise:

A subcategory of physical activity that is planned, structured, repetitive, and purposive in the sense that the improvement or maintenance of one or more components of physical fitness is the objective.

Workout:

A “workout” is a term that refers to the period of time spent exercising — the exercise event. That makes “working out” the same thing as “exercise.”

Training:

“Training” is the process of moving from one state of physical preparedness to another. The individual workouts that compose the elements of the process are important not in and of themselves, but because their cumulative effect accomplishes a specific definable physical goal. To an athlete who is “training” for a performance goal, be it a marathon or a weightlifting meet, the accumulated, increasing stress that characterizes “training” must be specific to the performance goal. This means that “training” must be carefully planned in advance to produce a specific adaptation at a specific point in time. This planning differentiates “training” from “exercise.”

Exercise training:

Physical activity performed during leisure time with the primary purpose of improving or maintaining physical fitness, physical performance, or health.

Physical inactivity:

Physical inactivity means physical activity levels less than those required for optimal health and prevention of premature death.

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“Physical activity,” “exercise,” and “physical fitness” are terms that describe different concepts. However, they are often confused with one another, and the terms are sometimes used interchangeably.  Physical activity is defined as any bodily movement produced by skeletal muscles that result in energy expenditure. The energy expenditure can be measured in kilocalories. Physical activity in daily life can be categorized into occupational, sports, conditioning, household, or other activities. Exercise is a subset of physical activity that is planned, structured, and repetitive and has as a final or an intermediate objective the improvement or maintenance of physical fitness. Physical fitness is a set of attributes that are either health- or skill-related. The degree to which people have these attributes can be measured with specific tests.

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Physical activity is movement that is carried out by the skeletal muscles that requires energy. In other words, any movement one does is actually physical activity.  This simply means getting up and moving around – doing household chores, raking leaves or walking the dog – is physical activity.  Exercise, however, is planned, structured, repetitive and intentional movement intended to improve or maintain physical fitness. Exercise is a subcategory of physical activity. Physical activity is an inclusive term that refers to any expenditure of energy brought about by bodily movement via the skeletal muscles; as such, it includes the complete spectrum of activity from very low resting levels to maximal exertion. Exercise is a component of physical activity. The distinguishing characteristic of exercise is that it is a structured activity specifically planned to develop and maintain physical fitness. Examples of physical activity are housework, gardening, moving up and down on stairs leaving elevators, and walking. Examples of exercises are cardio exercises, weightlifting, brisk walking, running, etc. If you are not fond of going to the gym, you can engage in swimming, cycling, running, and sports such as golf and tennis. They can also serve as good exercise for your body. Physical conditioning refers to the development of physical fitness through the adaptation of the body and its various systems to an exercise program. Physical fitness includes cardiorespiratory fitness, muscle strength, body composition, and flexibility, comprising a set of attributes that people have or achieve that relates to the ability to perform physical activity.

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The term “physical activity” describes many forms of movement, including activities that involve the large skeletal muscles.  Activities that involve the small skeletal muscles (e.g. playing board games, drawing, writing) are important, but they do not provide the health benefits of activities that involve the large skeletal muscles and require substantial energy expenditure.

Physical activity is defined by its duration, intensity, and frequency

1. Duration is the amount of time spent participating in a physical activity session

2. Intensity is the rate of energy expenditure

3. Frequency is the number of physical activity sessions during a specific time period (e.g. one week).

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Types of Physical Activity:

1. Aerobic – light to vigorous-intensity physical activity that requires more oxygen than sedentary behavior and thus promotes cardiovascular fitness and other health benefits (e.g., jumping rope, biking, swimming, running; playing soccer, basketball, or volleyball).

2. Anaerobic – intense physical activity that is short in duration and requires a breakdown of energy sources in the absence of sufficient oxygen. Energy sources are replenished as an individual recovers from the activity. Anaerobic activity (e.g. weight lifting) requires maximal performance during the brief period.

3. Lifestyle – physical activity typically performed on a routine basis (e.g., walking, climbing stairs, mowing or raking the yard), which is usually light to moderate in intensity.

4. Physical activity play – play activity that requires substantial energy expenditure (e.g., playing tag, jumping rope).

5. Play – activity with flexible rules, usually self-selected, for the purpose of having fun.

6. Sports – physical activity that involves competition, scorekeeping, rules, and an outcome that cannot be predetermined. There are two categories of sports: individual and team.

7. Weight-bearing – physical activity that requires people to move their own weight.

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What counts as exercise?

In the UK, regular exercise is defined by the NHS as completing 150 minutes of moderate intensity aerobic activity a week. Aerobic activity at moderate intensity basically means exercising at a level that raises your heart rate and makes you sweat. This includes a multitude of sports. For example;

•Fast paced walking

•Light jogging

•Bike riding

•Rowing

•Playing doubles tennis or badminton

•Water aerobics

Cutting the grass, cleaning your home and other daily chores such as shopping don’t count towards your 150 minutes of weekly exercise as advances in technology have made these activities far less demanding on the body than for previous generations, who were active naturally more active through work and manual labour. However, the less time you spend sitting down, the better it will be for your health. Sedentary behaviour, such as sitting or lying down for long periods, increases your risk of weight gain and obesity, which in turn, may also up your risk of chronic diseases such as heart disease and diabetes.

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Physical activity vs physical fitness:

Some people incorrectly use physical fitness and physical activity interchangeably. The CDC defines physical fitness as “The ability to carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy to enjoy leisure-time pursuits and respond to emergencies. Physical Fitness has a more specific definition by Kilgore and Rippetoe in the Journal of Exercise Physiology “Possession of adequate levels of strength, endurance, and mobility to provide for successful participation in occupational effort, recreational pursuits, familial obligation, and that is consistent with a functional phenotypic expression of the human genotype.” This is a description of what fitness entails, and describes a reason to be fit based on the genetics we possess. But it doesn’t say anything about how to accomplish this task, either the process or the components thereof.  Physical fitness includes a number of components consisting of cardiorespiratory endurance (aerobic power), skeletal muscle endurance, skeletal muscle strength, skeletal muscle power, flexibility, balance, speed of movement, reaction time, and body composition”.  Inherited genes and their interaction with physical activity levels determine physical fitness. However, chronic physical activity levels themselves modulate fitness. Further, the levels of physical activity themselves modulate whether fitness improves. For example, Sisson et al. concluded that the most important finding of their study was that greater volumes of exercise were associated with a lower probability of being a non-responder. The percentage of non-responders at a given level of training progressively decreased as the exercise volume increased.

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Physical fitness refers to a physiologic state of well-being that allows one to meet the demands of daily living or that provides the basis for sport performance, or both. Health-related physical fitness involves the components of physical fitness related to health status, including cardiovascular fitness, musculoskeletal fitness, body composition and metabolism. In large epidemiologic investigations, physical activity and physical fitness are often used interchangeably, with fitness commonly being treated as a more accurate (albeit indirect) measure of physical activity than self-report. Physical fitness appears to be similar to physical activity in its relation to morbidity and mortality but is more strongly predictive of health outcomes than physical activity.  Most analyses have shown a reduction of at least 50% in mortality among highly fit people compared with low-fit people. Nonetheless, both physical activity and fitness are strong predictors of risk of death. To obtain accurate estimates of physical activity, many fitness consultants rely on primary criterion (gold standard) for the measurement of energy expenditure, such as direct observation of movement or, in the laboratory, the doubly labelled water technique or indirect calorimetry. On a practical basis, however, measures of physical activity and energy expenditure are obtained by using heart rate monitors and motion sensors (pedometers and accelerometers). The assessment of physical fitness is often not feasible or practical in large population-based investigations. Fortunately such studies have consistently shown an inverse gradient of health risk across self-reported physical activity groups. From a public health perspective, Blair and colleagues have argued that it is preferable to encourage people to become more physically active rather than to become physically fit, since, as they stated, sedentary people will likely achieve the latter if they do the former.

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Health-related physical fitness:

Health-related physical fitness is defined as fitness related to some aspect of health. This type of physical fitness is primarily influenced by an individual’s exercise habits; thus, it is a dynamic state and may change. Physical characteristics that constitute health-related physical fitness include strength and endurance of skeletal muscles, joint flexibility, body composition, and cardiorespiratory endurance. All these attributes change in response to appropriate physical conditioning programs, and all are related to health. Health related physical fitness consists of four specific components:

-Cardiorespiratory fitness

-Muscular strength/endurance fitness

-Flexibility fitness

-Body composition

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1. Cardiorespiratory endurance/fitness, or aerobic fitness, is probably what most people identify as physical fitness. Aerobic fitness refers to the integrated functional capacity of the heart, lungs, vascular system, and skeletal muscles to expend energy. The basic activity that underlies this type of fitness is aerobic metabolism in the muscle cell, a process in which oxygen is combined with a fuel source (fats or carbohydrates) to release energy and produce carbon dioxide and water. The energy is used by the muscle to contract, thereby exerting force that can be used for movement. For the aerobic reaction to take place, the cardiorespiratory system (i.e., the circulatory and pulmonary systems) must constantly supply oxygen and fuel to the muscle cell and remove carbon dioxide from it. The maximal rate at which aerobic metabolism can occur is thus determined by the functional capacity of the cardiorespiratory system and is measured in the laboratory as maximal oxygen intake. Cardiorespiratory fitness (CRF) is the capacity of the cardiovascular (heart and blood vessels) and respiratory (lungs) systems to supply oxygen-rich blood to the working skeletal muscles and the capacity of the muscles to use oxygen to produce energy for movement. The gold standard to determine CRF is VO2max, or maximum aerobic fitness. However in large clinical human studies, an acceptable surrogate for VO2max is the length of time running or cycling in standardized test, assuming appropriate physiological/ biochemical/ psychological proof of exhaustion is obtained. The majority of data about fitness and physical activity is focused on aerobic fitness. Data indicates that rapid, severe physical inactivity can rapidly decrease CRF. For instance, in the Dallas Bed Rest study, healthy, young males’ VO2max decreased 27% after 20 days of continuous bed rest and another study in Denmark 2 weeks of reducing daily step number from 10,501 to 1344 VO2max decreased 7%.  Aerobic fitness is inversely related to the incidence of coronary heart disease and hypertension.

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2. Strength fitness is the capacity of the skeletal muscle to move an external load. Strength is highly dependent upon skeletal muscle mass, which contains a major genetic component, and is sensitive to decreased mechanical loading resulting in skeletal muscle atrophy regardless of endowed muscle mass. Strength and endurance of skeletal muscles of the trunk help maintain correct posture and prevent such problems as low back pain. Minimal levels of muscular strength and endurance are needed for routine tasks of living, such as carrying bags of groceries or picking up a young child. Individuals with very low levels of muscular strength and endurance are limited in the performance of routine tasks and have to lead a restricted life. Such limitations are perhaps only indirectly related to health, but individuals who cannot pick up and hug a grandchild or must struggle to get up from a soft chair surely have a lower quality of life than that enjoyed by their fitter peers.

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3. Flexibility, or range of motion around the joints, also ranks as an important component of health-related fitness. Lack of flexibility in the lower back and posterior thigh is thought to contribute to low back pain. Extreme lack of flexibility also has a deleterious effect on the quality of life by limiting performance. Balance fitness is the ability to control the body’s position throughout movement, and flexibility fitness is the ability to achieve an extended range of motion. Both have components of genetic inheritability and are also trainable.

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4. Body composition refers to the ratio between fat and lean tissue in the body. Excess body fat is clearly related to several health problems, including cardiovascular disease, type II diabetes mellitus, and certain forms of cancer. Body composition is affected by diet, but exercise habits play a crucial role in preventing obesity and maintaining acceptable levels of body fat.

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Musculoskeletal fitness: a paradigm shift:

Improvements in indicators of health status can occur as a result of increasing physical activity levels in the absence of changes in aerobic fitness. This is particularly evident in elderly populations, where regular physical activity can lead to reductions in risk factors for chronic disease and disability without markedly changing traditional physiologic performance markers (e.g., cardiac output and oxidative potential).  Furthermore, routine physical activity can improve musculoskeletal fitness.  There is increasing evidence that enhanced musculoskeletal fitness is associated with an improvement in overall health status and a reduction in the risk of chronic disease and disability. This research has led to a shift in focus in research related to the health benefits of activities that tax the musculoskeletal system.

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Musculoskeletal fitness appears to be particularly important for elderly people and their ability to maintain functional independence. In fact, many activities of daily living do not require a large aerobic output but depend on one or more of the musculoskeletal fitness components.  Many healthy elderly people may be at or near the functional threshold for dependence, wherein they are in jeopardy of losing the capacity to carry out the activities of daily living. With further worsening of musculoskeletal fitness, an individual may lose the capacity to perform daily activities, such as getting out of a chair or climbing stairs. This represents a cycle of decline, where reduced musculoskeletal fitness leads to inactivity and further dependence. As illustrated in figure below, improvements in musculoskeletal function have an enormous potential for delaying or eliminating the onset of disability, dependence and chronic disease. For instance, previous longitudinal investigations have revealed that people with high levels of muscular strength have fewer functional limitations and lower incidences of chronic diseases such as diabetes, stroke, arthritis, coronary artery disease and pulmonary disorders.

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Improvements in musculoskeletal fitness delays or eliminate disability:

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Two recent systematic reviews have revealed that enhanced musculoskeletal fitness is positively associated with functional independence, mobility, glucose homeostasis, bone health, psychological well-being and overall quality of life and is negatively associated with the risk of falls, illness and premature death. Interventions that improve musculoskeletal fitness appear to be particularly important for improving the health status of frail elderly people (who have a low musculoskeletal reserve).  This research has revealed clearly the importance of engaging in activities that tax the musculoskeletal system and is supported by findings from a recent epidemiologic investigation. This evidence provides direct support for the recent recommendation that resistance training and flexibility exercises be performed at least twice a week to maintain functional status, promote lifelong physical activity and enhance overall quality of life.

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Fitness and training program:

Supercompensation:

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The fitness level of a human body in training can be broken down into four periods: initial fitness, training, recovery, and supercompensation. During the initial fitness period, the target of the training has a base level of fitness (shown by the first time sector in the graph). Upon entering the training period, the target’s level of fitness decreases (shown by the second time sector in the graph). After training, the body enters the recovery period during which level of fitness increases up to the initial fitness level (shown by the third time sector in the graph). Because the human body is an adjustable organism, it will feel the need to adjust itself to a higher level of fitness in anticipation of the next training session. Accordingly, the increase in fitness following a training session does not stop at the initial fitness level. Instead the body enters a period of supercompensation during which fitness surpasses the initial fitness level (shown by the fourth time sector in the graph). If there are no further workouts, the body’s fitness level will slowly decline back towards the initial fitness level (shown by the last time sector in the graph). First put forth by Russian scientist Nikolai N. Yakovlev (1911–1992) in 1949-1959, this theory is a basic principle of athletic training. If the next workout takes place during the recovery period, overtraining may occur. If the next workout takes place during the supercompensation period, the body will advance to a higher level of fitness. If the next workout takes place after the supercompensation period, the body will remain at the base level. More complex variations are possible; for instance, sometimes a few workouts are intentionally made in the recovery period to achieve greater supercompensation effects.

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Types of exercise:

Exercises are generally grouped into three types depending on the overall effect they have on the human body:

• Aerobic exercise is any physical activity that uses large muscle groups and causes your body to use more oxygen than it would while resting. Aerobic exercises, such as cycling, walking, running, hiking, and playing tennis, focus on increasing cardiovascular endurance.

•Anaerobic exercise is also called strength or resistance training and can firm, strengthen, and tone your muscles, as well as improve bone strength, balance, and coordination.  Examples of strength moves are pushups, lunges, and bicep curls using dumbbells.  Anaerobic exercise also includes weight training, functional training, eccentric training, Interval training, sprinting and high-intensity interval training increase short-term muscle strength.

•Flexibility exercises such as stretching improve the range of motion of muscles and joints. The goal is to improve the range of motion which can reduce the chance of injury.

A balanced program should include all three. Physical exercise can also include training that focuses on accuracy, agility, power, and speed. Speed training is a major category, but generally only competitive athletes practice it.

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Dynamic vs static exercise:

‘Dynamic’ exercises such as steady running tend to produce a lowering of the diastolic blood pressure during exercise, due to the improved blood flow. Conversely, static exercise (such as weight-lifting) can cause the systolic pressure to rise significantly (during the exercise).

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Aerobic exercise (also known as cardio or cardiovascular exercise, a term attributed to this kind of exercise because of its various benefits in cardiovascular health):

A physical therapist, Col Pauline Potts, and an exercise physiologist, Kenneth Cooper M.D., both in the US Air Force, were the first to use the term aerobic exercise during the 1960s. Dr. Cooper wanted to find out why some very strong people were poor at long-distance running, swimming and cycling. He researched people’s performance in terms of their ability to use oxygen with the use of a bicycle ergometer. In 1968 Dr. Cooper published his book Aerobics. The book included scientific programs using aerobic exercises, such as swimming, running, cycling and walking. The book became a bestseller. All present aerobic programs use Cooper’s data as a baseline.

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Aerobic exercise (also known as cardio) is physical exercise of low to moderate intensity that depends primarily on the aerobic energy-generating process.  Aerobic literally means “relating to, involving, or requiring free oxygen”, and refers to the use of oxygen to adequately meet energy demands during exercise via aerobic metabolism. Generally, light-to-moderate intensity activities that are sufficiently supported by aerobic metabolism can be performed for extended periods of time.  Most aerobic exercises are done at moderate levels of intensity for longer periods, compared to other categories of exercise. An aerobic exercise session involves warming up, exercising for at least 20 minutes, and then cooling down. Aerobic exercise involves mainly the large muscle groups. Running for 20 minutes is an aerobic exercise, while sprinting 200 meters is not. Playing badminton for 30 minutes is an aerobic activity if the movements of the players are fairly continuous. Golf, on the other hand, is not seen as aerobic because the heart rate has not been raised at a sustained level for long enough. Some sports are thus inherently “aerobic”, while other aerobic exercises, such as fartlek training or aerobic dance classes, are designed specifically to improve aerobic capacity and fitness. It is most common for aerobic exercises to involve the leg muscles, primarily or exclusively. There are some exceptions. For example, rowing to distances of 2,000 m or more is an aerobic sport that exercises several major muscle groups, including those of the legs, abdominals, chest, and arms. Common kettlebell exercises combine aerobic and anaerobic aspects. Many types of exercise are aerobic, and by definition are performed at moderate levels of intensity for extended periods of time. This intensity can vary from 50-80% of maximum heart rate.

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Among the recognized benefits of doing regular aerobic exercise are:

•Strengthening the muscles involved in respiration, to facilitate the flow of air in and out of the lungs

•Strengthening and enlarging the heart muscle, to improve its pumping efficiency and reduce the resting heart rate, known as aerobic conditioning

•Improving circulation efficiency and reducing blood pressure

•Increasing the total number of red blood cells in the body, facilitating transport of oxygen

•Improved mental health, including reducing stress and lowering the incidence of depression, as well as increased cognitive capacity.

•Reducing the risk for diabetes. One meta-analysis has shown, from multiple conducted studies, that aerobic exercise does help lower HbA1C levels for type 2 diabetics.

As a result, aerobic exercise can reduce the risk of death due to cardiovascular problems. In addition, high-impact aerobic activities (such as jogging or using a skipping rope) can stimulate bone growth, as well as reduce the risk of osteoporosis for both men and women.

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Both the health benefits and the performance benefits, or “training effect”, require a minimum duration and frequency of exercise. Most authorities suggest at least twenty minutes performed at least three times per week. The average healthy person should engage in 150–200 minutes of moderate aerobic exercise every week. This amount of physical activity should help with maintaining a healthy weight and keeping the cardiovascular system in good condition.

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In addition to the health benefits of aerobic exercise, there are numerous performance benefits:

•Increased storage of energy molecules such as fats and carbohydrates within the muscles, allowing for increased endurance

•Neovascularization of the muscle sarcomeres to increase blood flow through the muscles

•Increasing speed at which aerobic metabolism is activated within muscles, allowing a greater portion of energy for intense exercise to be generated aerobically

•Improving the ability of muscles to use fats during exercise, preserving intramuscular glycogen

•Enhancing the speed at which muscles recover from high intensity exercise

•Neurobiological effects: improvements in brain structural connections and increased grey matter density, new neuron growth, improved cognitive function (cognitive control and various forms of memory), and improvement or maintenance of mental health

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Some downfalls of aerobic exercise include:

•Overuse injuries because of repetitive, high-impact exercise such as distance running.

•Is not an effective approach to building muscle.

•Only effective for fat loss when used consistently.

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Aerobic conditioning:

Aerobic conditioning is a process whereby the heart and lungs are trained to pump blood more efficiently, allowing more oxygen to be delivered to muscles and organs. Aerobic condition is usually achieved through cardiovascular exercise such as running, swimming, aerobics, etc. A stronger heart does not pump more blood by beating faster but by beating more efficiently. Trained endurance athletes can have resting heart rates as low as the reported 28 beats per minute in people such as Miguel Indurain or 32 beats per minute of Lance Armstrong, both of whom were professional cyclists at the highest level. Although exercising at lower intensities will improve aerobic conditioning, the most rapid gains are made when exercising close to an individual’s anaerobic threshold. This is the intensity at which the heart and lungs can no longer provide adequate oxygen to the working muscles and an oxygen debt begins to accrue; at this point the exercise becomes anaerobic. Anaerobic training intensity for most individuals will be <85-92% of maximum heart rate.  Once improvement in aerobic conditioning is apparent, for example in metabolism and oxygen uptake, the body will progressively adapt to further training.  Aerobic conditioning can be anywhere from walking on the treadmill to mowing the lawn. Aerobic conditioning has many advantages over anaerobic as it can increase physical endurance and lifespan. During aerobic training, the aim is to improve the blood flow to the lungs, heart, and blood vessels. This particular type of training targets large muscle groups so that as the intensity of physical activity is increased, overall fitness is improved. There are many benefits to aerobic training, and the outcomes can be very rewarding. Aerobic conditioning can increase the duration that one can endure physical activity. This type of conditioning can help with heart disease, diabetes, or anxiety. Aerobic conditioning also has many non-medical benefits, such as improving mood, alleviating fatigue and stabilizing sleeping patterns. This overall type of conditioning has the most longevity to its practice and can improve a person’s health and general well-being immensely.

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Anaerobic exercise:

Anaerobic means without air. Oxygen is not used for energy generation during anaerobic exercise. Anaerobic exercise is an exercise intense enough to trigger lactate formation. It is used by athletes in non-endurance sports to promote strength, speed and power and by body builders to build muscle mass. Muscle energy systems trained using anaerobic exercise develop differently compared to aerobic exercise, leading to greater performance in short duration, high intensity activities, which last from mere seconds to up to about 2 minutes. The muscles are exercised at high intensity for short durations. A short duration usually means no more than about two minutes.  Any activity lasting longer than about two minutes has a large aerobic metabolic component.

Anaerobic exercises include:

•Weight lifting

•Sprinting

•Intensive and fast skipping (with a rope)

•Interval training

•Isometrics

•Any rapid burst of hard exercise

During this type of exercise a by-product – lactic acid – is produced. Lactic acid contributes to muscle fatigue and must be used up during recovery before that muscle can be subjected to another anaerobic session. During the recovery period oxygen is used to give the muscle a “refill” – to replenish the muscle’s energy that was used up during the intensive exercise.  Overall, anaerobic exercise uses up fewer calories than aerobic exercise. The cardiovascular benefits of aerobic exercises are greater than the cardiovascular benefits of anaerobic exercises. However, anaerobic exercise is better at building strength and muscle mass, while still benefitting the heart and lungs. As you build more muscle you will burn more fat, even at rest. Muscles burn more calories per unit volume than any other tissue in the body. A muscly person burns more calories than a non-muscly person, even if while he/she is resting. A study found that resistance training may aid in weight loss.

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Anaerobic exercises offer the following benefits:

•The exerciser gets stronger

•The exerciser experiences growth in muscle mass

•Strengthens bones

•Strengthens and protects the joints

•Helps control bodyweight

•The exerciser can withstand a greater buildup of lactic acid (improved lactate tolerance) and other waste substances, and can eliminate them more rapidly

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Strength training:

Strength training is a type of physical exercise specializing in the use of resistance to induce muscular contraction which builds the strength, anaerobic endurance, and size of skeletal muscles. When properly performed, strength training can provide significant functional benefits and improvement in overall health and well-being, including increased bone, muscle, tendon and ligament strength and toughness, improved joint function, reduced potential for injury, increased bone density, increased metabolism, increased fitness, improved cardiac function, and improved lipoprotein lipid profiles, including elevated HDL (“good”) cholesterol. Training commonly uses the technique of progressively increasing the force output of the muscle through incremental weight increases and uses a variety of exercises and types of equipment to target specific muscle groups. Strength training is primarily an anaerobic activity, although some proponents have adapted it to provide the benefits of aerobic exercise through circuit training.

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Benefits of strength/resistance exercise/training:

While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

•Build muscle strength while burning fat

•Help maintain bone density

Strength-training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called “bad” cholesterol) levels. Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Please note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

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Weighted clothing:

Weighted clothing is clothing that adds weight to various parts of the body, usually as part of resistance training. The effect is achieved through attaching weighted pieces to the body (or to other garments) which leave the hands free to grasp objects. The method may increase muscle mass or lose weight; however, there have been concerns about the safety of some uses of weights, such as wrist and ankle weights. It is normally done in the form of small weights, attached to increase endurance when performed in long repetitive events, such as running, swimming, punching, kicking or jumping. Heavier weighted clothing can also be used for slow, controlled movements, and as a way to add resistance to body-weight exercises.

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How does Anaerobic Exercise work?

When a short, intensive burst of activity occurs there is a temporary shortage of oxygen being delivered to the working muscles at first. The production of anaerobic energy creates a by-product; lactic acid and lactic acid causes muscle fatigue, which is the reason the session cannot last long. However, after regular training the person’s body becomes better equipped to handle lactic acid. After several practice sessions the body becomes better at getting rid of lactic acid – it also learns how to produce less of it. The body also produces buffers that postpone the onset of fatigue during an anaerobic session.

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Anaerobic Metabolism:

Anaerobic metabolism, or anaerobic energy expenditure, is a natural part of whole-body metabolic energy expenditure. Fast twitch muscle (as compared to slow twitch muscle) operates using anaerobic metabolic systems, such that any recruitment of fast twitch muscle fibers leads to increased anaerobic energy expenditure. Intense exercise lasting upwards of about four minutes (e.g., a mile race) may still have a considerable anaerobic energy expenditure component. High-intensity interval training, although based on aerobic exercises like running, cycling and rowing, effectively become anaerobic when performed in excess of 90% maximum heart rate. Anaerobic energy expenditure is difficult to accurately quantify, although several reasonable methods to estimate the anaerobic component to exercise are available. In contrast, aerobic exercise includes lower intensity activities performed for longer periods of time. Activities such as walking, long slow runs, rowing, and cycling require a great deal of oxygen to generate the energy needed for prolonged exercise (i.e., aerobic energy expenditure). In sports which require repeated short bursts of exercise however, the anaerobic system enables muscles to recover for the next burst. Therefore training for many sports demands that both energy producing systems be developed.

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The two types of anaerobic energy systems are: 1) high energy phosphates, ATP adenosine triphosphate and CP creatine phosphate; and 2) anaerobic glycolysis. High energy phosphates are stored in limited quantities within muscle cells. Anaerobic glycolysis exclusively uses glucose (and glycogen) as a fuel in the absence of oxygen, or more specifically when ATP is needed at rates that exceed those provided by aerobic metabolism. The consequence of such rapid glucose breakdown is the formation of lactic acid (or more appropriately, its conjugate base lactate at biological pH levels). Physical activities that last up to about thirty seconds rely primarily on the former, ATP-CP phosphagen system. Beyond this time both aerobic and anaerobic glycolysis-based metabolic systems begin to predominate. The by-product of anaerobic glycolysis, lactate, has traditionally been thought to be detrimental to muscle function. However, this appears likely only when lactate levels are very high. Elevated lactate levels are only one of many changes that occur within and around muscle cells during intense exercise that can lead to fatigue. Fatigue, that is muscle failure, is a complex subject. Elevated muscle and blood lactate concentrations are a natural consequence of any physical exertion. The effectiveness of anaerobic activity can be improved through training.

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Aerobic versus anaerobic exercise:

The figure above illustrates Fox and Haskell formula showing the split between aerobic (light orange) and anaerobic (dark orange) exercise and heart rate. During aerobic exercise, target heart rate is 70-80 % of maximum heart rate while during anaerobic exercise, target heart rate is 80-90 % of maximum heart rate.  Aerobic exercise and fitness can be contrasted with anaerobic exercise, of which strength training and short-distance running are the most salient examples. The two types of exercise differ by the duration and intensity of muscular contractions involved, as well as by how energy is generated within the muscle.

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In almost all conditions, anaerobic exercise is accompanied by aerobic exercises because the less efficient anaerobic metabolism must supplement the aerobic system due to energy demands that exceed the aerobic system’s capacity. What is generally called aerobic exercise might be better termed “solely aerobic”, because it is designed to be low-intensity enough not to generate lactate via pyruvate fermentation, so that all carbohydrate is aerobically turned into energy. Initially during increased exertion, muscle glycogen is broken down to produce glucose, which undergoes glycolysis producing pyruvate which then reacts with oxygen (Krebs cycle) to produce carbon dioxide and water and releases energy. If there is a shortage of oxygen (anaerobic exercise, explosive movements), carbohydrate is consumed more rapidly because the pyruvate ferments into lactate. If the intensity of the exercise exceeds the rate with which the cardiovascular system can supply muscles with oxygen, it results in buildup of lactate and quickly makes it impossible to continue the exercise. Unpleasant effects of lactate buildup initially include the burning sensation in the muscles, and may eventually include nausea and even vomiting if the exercise is continued without allowing lactate to clear from the bloodstream. As glycogen levels in the muscle begin to fall, glucose is released into the bloodstream by the liver, and fat metabolism is increased so that it can fuel the aerobic pathways. Aerobic exercise may be fuelled by glycogen reserves, fat reserves, or a combination of both, depending on the intensity. Prolonged moderate-level aerobic exercise at 65% VO2 max (the heart rate of 150 bpm for a 30-year-old human) results in the maximum contribution of fat to the total energy expenditure. At this level, fat may contribute 40% to 60% of total, depending on the duration of the exercise. Vigorous exercise above 75% VO2max (160 bpm) primarily burns glycogen. Major muscles in a rested, untrained human typically contain enough energy for about 2 hours of vigorous exercise. Exhaustion of glycogen is a major cause of what marathon runners call “hitting the wall”. Training lowers intensity levels, and carbohydrate loading may allow postponement of the onset of exhaustion beyond 4 hours.

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The figure above shows that during maximum effort exercise, anaerobic metabolism dominates up to 2 minutes and then aerobic metabolism dominates in the large skeletal muscles.

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Interval training:

Interval training is a type of physical training that involves a series of low- to high-intensity exercise workouts interspersed with rest or relief periods. The high-intensity periods are typically at or close to anaerobic exercise, while the recovery periods involve activity of lower intensity aerobic exercise. This can mean simply speeding up your walk to a jog for a few minutes. The high intensity portion are called Sprint Intervals. Sprint intervals are measured either by time or distance. The periods of recovery are called Rest Intervals. During a rest interval athletes do not stop the activity but generally exercise at a low intensity which allows the body to recover from the sprint interval. The intervals are important; the basis of the interval training is to ensure that your sprints are done at an optimal intensity, without sufficient rest your interval training will resort back to an aerobic type of activity. High-intensity interval training attempts to decrease the overall volume of training by increasing the effort expended during the high-intensity intervals. The idea is short explosions of exercise that get your heart rate up followed by periods of rest or lower intensity providing a greater benefit.

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Our body has three types of muscle fibers: slow, fast, and super-fast twitch muscles, and these muscles have two different metabolic processes:

•The aerobic, which requires oxygen for fuel burning

•The anaerobic, which does not require any oxygen

Slow twitch muscles are the red muscles, which are activated by traditional strength training and cardio exercises. The fast and super-fast twitch muscles are white muscle fibers, which are only activated during high intensity interval exercises or sprints. Activating the fast and super-fast muscles is also what causes the production of therapeutic levels of growth hormone. Now, traditional cardio exercises work primarily the aerobic process, associated with your red, slow-twitch muscles. High-intensity interval training, on the other hand, work both your aerobic and your anaerobic processes, which is what you need for optimal cardiovascular benefit. Quite simply, if you don’t actively engage and strengthen all three muscle fiber types and energy systems, then you’re not going to work both processes of your heart muscle. Many mistakenly believe that cardio works out your heart muscle, but what you’re really working is your slow twitch muscle fibers, associated with the aerobic process only. You’re not effectively engaging the anaerobic process of your heart… By changing up exercises in a single period, exercisers are improving both their endurance and speed during one exercise session. There is also thought to be a benefit of reaching your “total maximum capability”—basically working your body as hard as you can—which is hard to do for a long period of time.  You increase your heart rate and total intensity to a higher level than you could during continuous activity.  Almost everyone can do something continuously at 50% of their maximum ability. But, you if you can take it to a higher intensity in short bouts, your body gets stimulated in ways it wouldn’t otherwise. The research on interval training—regardless of ultimate level of intensity—is encouraging. It shows that mixing it up provides more benefits, and keeps things interesting. It’s not for everyone, since some people may find upping their fitness levels in various cycles too challenging, while someone running a marathon needs to dedicate lots of time to continuous exercise and long runs.

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Circuit training:

With circuit workouts a number of exercises are performed back to back. They are performed in a set order, with a specific time or number of repetitions for each one, and rest periods are allotted between them. An exercise “circuit” is one completion of all prescribed exercises in the program. When one circuit is complete, one begins the first exercise again for the next circuit. Traditionally, the time between exercises in circuit training is short, often with rapid movement to the next exercise. Circuit training is great for burning extra calories in a short amount of time. Since they are more intense, training in this manor is very effective for losing weight or increasing your cardiovascular capacity or muscle endurance. Circuits are also great for increasing your muscular strength.

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Cross-training:

Cross-training refers to the combining of exercises to work various parts of the body. Often one particular activity works certain muscle groups, but not others; cross-training aims to eliminate this. Cross-training is a technique where you alternate exercise modes (activities) in order to use different muscles. This helps to make sure that all of your muscles get a work-out during the week and also helps to prevent overuse injuries. For example, a cross-training regimen may include swimming two days a week, jogging two days a week, and using exercise gym equipment such as an elliptical trainer or stair stepper two days a week. It is standard practice to have athletes cross train in order to optimize their fitness levels and to minimize their risk of being sidelined by an injury.

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Isometric exercise:

During isometric exercises, muscles contract. However, there is no motion in the affected joints. The muscle fibers maintain a constant length throughout the entire contraction. The exercises usually are performed against an immovable surface or object such as pressing one’s hand against a wall. The muscles of the arm are contracting but the wall is not reacting or moving in response to the physical effort. Isometric training is effective for developing total strength of a particular muscle or group of muscles. It often is used for rehabilitation since the exact area of muscle weakness can be isolated and strengthening can be administered at the proper joint angle. This kind of training can provide a relatively quick and convenient method for overloading and strengthening muscles without any special equipment and with little chance of injury.

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Isotonic exercise:

Isotonic exercise differs from isometric exercise in that there is movement of a joint during the muscle contraction. A classic example of an isotonic exercise is weight training with dumbbells and barbells. As the weight is lifted throughout the range of motion, the muscle shortens and lengthens. Calisthenics are also an example of isotonic exercise. These would include chin-ups, push-ups, and sit-ups, all of which use body weight as the resistance force.

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Calisthenics:

Calisthenics are a form of exercise that consists of a variety of gross motor movements, often rhythmical, generally without using equipment or apparatus, thus in all essence body-weight training. They are intended to increase body strength, body fitness and flexibility through movements such as pulling or pushing yourself up, bending, jumping, or swinging, using only one’s body weight for resistance. They are usually conducted in concert with stretches. When performed vigorously and with variety, calisthenics can provide the benefits of muscular and aerobic conditioning, in addition to improving psychomotor skills such as balance, agility and coordination.

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Isokinetic exercise:

Isokinetic exercise utilizes machines that control the speed of contraction within the range of motion. Isokinetic exercise attempts to combine the best features of both isometrics and weight training. It provides muscular overload at a constant preset speed while a muscle mobilizes its force through the full range of motion. For example, an isokinetic stationary bicycle set at 90 revolutions per minute means that no matter how hard and fast the exerciser works, the isokinetic properties of the bicycle will allow the exerciser to pedal only as fast as 90 revolutions per minute. Machines known as Cybex and Biodex provide isokinetic results; they generally are used by physical therapists.

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Flexibility Training (Stretching):

Flexibility training uses stretching exercises. Stretching is a form of physical exercise in which a specific muscle or tendon (or muscle group) is deliberately flexed or stretched in order to improve the muscle’s felt elasticity and achieve comfortable muscle tone. The result is a feeling of increased muscle control, flexibility, and range of motion. Stretching is also used therapeutically to alleviate cramps. In its most basic form, stretching is a natural and instinctive activity; it is performed by humans and many other animals. It can be accompanied by yawning. Stretching often occurs instinctively after waking from sleep, after long periods of inactivity, or after exiting confined spaces and areas. Increasing flexibility through stretching is one of the basic tenets of physical fitness. It is common for athletes to stretch before and after exercise in order to reduce injury and increase performance. It is suggested that one stretching exercise may not be enough to prevent all types of injury, and that, multiple stretching exercises should be used to gain the full effects of stretching. It has also been suggested that proprioceptive neuromuscular facilitation (PNF) stretching yields the greatest change in range of motion, especially short-term benefits. It is also has reduced chance of injury because it allows for the stretched muscle time to adapt to the stretched position. If done properly, stretching can prevent injury, relax the muscles, increase range of motion and flexibility, and better one’s performance, especially athletes. Stretching increases blood flow which prevents hardening of the arteries and it also produces synovial fluid, which lubricates the joints that are surrounded by the muscles; which in turn helps prevent arthritis. Stretching stabilizes the body’s natural balance and posture, and aligns the joints leading to better coordination. Certain flexibility practices, such as yoga and tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

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Incorporate variety of exercise for optimal health:

For optimal health, add variety to your fitness routine.  Ideally, to truly optimize all aspects of your health, you’d be wise to design a well-rounded fitness program that incorporates a variety of different exercises. Without variety, your body will quickly adapt, so as a general rule, as soon as an exercise becomes easy to complete, you’ll want to increase the intensity and/or try another exercise to keep it challenging. Incorporate various types of exercise in your routine cardio; interval training, strength training, core exercise, stretching and avoid prolonged sitting.

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Gymnasium (gym) vs. home exercise:

To go to gym, you have to get dressed, drive to the gym, and change into your workout clothes. Then, after working out, you have to do it all again in the opposite order. All of this can take more time than the actual workout. The appeal of gyms is further hampered by rising membership costs and the limited amount of time you can exercise as the result of crowds during busy hours. Because of these factors, Delavier and co-author Michael Gundill think there are six major reasons why working out at home is the right choice for anyone looking to build mass:

1. Home offers a place that fits your program.

Sometimes gym patrons think it’s strange to see people who are seriously working out. Gyms certainly have a more social quality than your home can offer, but being social does not make your workout effective. Often, the opposite is true.

2. Home offers a place to get the results you desire.

Strength training must be practiced seriously and not taken lightly. Unfortunately, most gyms do not want people who think that way as members.  Gyms emphasize the fun aspects of exercising and do not focus on effectiveness. This is why gyms often choose equipment that looks nice over equipment that works well.

3. Home offers a chance to use effective equipment.

In many gyms, the equipment choices were made based on cost rather than effectiveness. At home, people have the option of using high-quality equipment that works well with human anatomy and is not dangerous for muscles and joints.

4. Home offers an environment where you can better concentrate.

At home, no one will disturb you while you are exercising. You’ll be able to remain focused and have a faster, more productive workout.

5. Home offers the best way to achieve the workout you planned.

In a gym, your time spent resting is largely determined by other gym members, as is your choice of exercises and equipment.  Circuit training, which is indispensable for an athlete’s bodybuilding, is next to impossible in a gym. Working out at home grants you this freedom.

6. Home offers the chance to exercise without ego.

In front of other people, weightlifters often perform their repetitions haphazardly with the goal of lifting as much as possible. This leads to slower progress and a greater risk of injury. At home, with no one to impress, you can focus on effective work and not worry about what others think.

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Gym positives:

•Friendly atmosphere

•Competition between lifters

•Extra motivation

•Lots of equipment

•People willing to help out/ Spotters

•Room for stretching, lifting etc..

•Random equipment such as belts, chalk and chains

•Sauna and pool to relax in

•Juice bar that offers variety of protein rich foods

•Personal trainers and special help

•People to socialize with

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Gym negatives:

•Annoying people

•Lack of motivation

•Jerks in the gym

•Crowded gym

•Too far away

•High expenses

•People with no goals

•Not enough free weights

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Does household work count as Exercise?

No.

If you think doing household chores will save you a trip to the gym, you might want to think again. A new study from Northern Ireland finds that people who report housework as part of their weekly exercise tend to be heavier than those who get their exercise through more traditional means. In fact, the more time people said they spent performing housework as exercise (which they considered moderate to vigorous physical activity), the heavier they tended to be. The findings are counterintuitive, the researchers said, because more physical activity — no matter what the form — should be linked with a lower weight, as long as people keep their calorie intake in check. The researchers speculated that people who say they exercise by doing housework are overestimating the intensity or duration of the activity. Or, it could be that people overestimate how many calories they burn doing chores, and eat too much, the researchers said. When you’re doing housework, you often end up snacking more, since you’re home and the fridge is right there. So even though doing housework does burn calories, it often doesn’t make up for the extra calories you take in while munching in the process. The findings suggest that housework “may not be sufficient to provide all of the benefits normally associated with meeting the physical-activity guidelines,” the researchers wrote in the journal BMC Public Health. In recent years, public health messages regarding physical activity have shifted from a focus on traditional exercises, such as running, to activities that can be performed as you go about your day, such as cycling to work, or gardening. However, these messages should instead emphasize the importance of practicing many different kinds of physical activity, and make sure that housework “is not seen as the main method” of exercising, another group of researchers said. The study, conducted by researchers at the University of Ulster, analyzed information from more than 4,600 people who were interviewed about their weekly physical activity. If the researchers excluded housework as a type of physical activity, only 20 percent of women met the physical-activity guidelines.

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Dancing:

Dancing is a fun and sociable way to obtain 30 mins of exercise a day. It is an aerobic exercise if done for more than

10 minutes, can strengthen the heart and encourage weight loss. More importantly it can improve muscle strength and balance and reduce mental and physical stress.

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Exercise in children:

Exercise is essential for improving overall health, maintaining fitness, and helping to prevent the development of obesity, hypertension, and cardiovascular disease. Surveys conducted by the Center for Disease Control and Prevention (CDC) indicate that 61.5 percent of children aged nine to 13 years do not participate in any organized physical activity (for example, sports, dance classes) and 22.6 percent are not physically active during their free time. According to the American Obesity Association, approximately 30 percent of children and adolescents aged six to 19 years are overweight and 15 percent are obese. A sedentary lifestyle and excess caloric consumption are the primary causes of this increase in overweight and obesity; regular exercise is considered an important factor in controlling weight. Given the increasing prevalence of overweight and obesity in children and adolescents, it is important for parents to encourage regular exercise and also serve as role models by exercising themselves. Television, computers, and video games have replaced physical activity for playtime for the majority of children. Parents should make a commitment to replacing sedentary activities with active indoor and outdoor games. Overweight and obese children and adolescents are at higher risk of developing several medical conditions, including the following:

• Asthma

• Diabetes

• Hypertension

• Orthopaedic complications, such as hip and knee pain and limited range of motion

• Cardiovascular disease

• High cholesterol

• Sleep apnea

• Psychosocial disorders, such as depression, negative body image, and eating disorders

For children and adolescents just beginning an exercise program, results (including weight loss, increased muscle strength, and aerobic capacity) will be noticeable in four to six weeks.

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The National Association for Sport and Physical Education (NASPE) offers these activity guidelines for infants, toddlers, and preschoolers:

Age Minimum Daily Activity Comments
Infant No specific requirements Physical activity should encourage motor development
Toddler 1½ hours 30 minutes planned physical activity and 60 minutes unstructured physical activity (free play)
Preschooler 2 hours 60 minutes planned physical activity and 60 minutes unstructured physical activity (free play)
School age 1 hour or more Break up into bouts of 15 minutes or more

Infants and young children should not be inactive for prolonged periods of time — no more than 1 hour unless they’re sleeping. And school-age children should not be inactive for periods longer than 2 hours.

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Role of Schools:

Early school physical education (PE) programs can make a significant difference, and the earlier these routines are learned the more likely they will be carried forth into a healthy adulthood. There are also physical benefits to PE programs that are just now becoming known. For example, a study found that incorporating jumping exercises into an elementary school’s PE program increased children’s bone densities, a measure of bone strength. Schools should emphasize team cooperation or individual improvement and self-mastery. Studies have shown that people tend to give up more quickly and feel less competent if their perceptions of success are based only on comparison to their peers.

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Myth: Children by nature have so much energy. They hardly sit still. There’s no need to spend time or energy teaching them about physical activity. They are already so active.

Fact: Each day children and youth aged 5 to 17, should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity to ensure healthy development. However, physical activity levels are decreasing among young people in countries around the world, especially in poor urban areas. This decline is largely due to increasingly common sedentary ways of life. For example fewer children walk or cycle to school and excessive time is devoted to watching television, playing computer games, and using computers – often at the expense of time and opportunities for physical activity and sports. Physical education and other school-based physical activities have also been decreasing. Importantly, patterns of physical activity and healthy lifestyles acquired during childhood and adolescence are more likely to be maintained throughout the life-span. Consequently, improving physical activity levels in young people is imperative for the future health of all populations.

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Proof that physical activity improves kids’ lives:

A study summarizes many studies that investigated the effect of physical activity and sport on health, fitness, lifestyle, educational success, social skills and the psychological well-being of children and teenagers. The many beneficial effects of physical activity and sport are represented in the diagram above. It’s a good visual representation of the fact that children who are running and jumping and physically competent are also better off cognitively, emotionally and socially. The fact that too many young people are not active enough has become a cause of great concern, and rightly so. As a spontaneous form of entertainment and a source of well-being, sports and physical activities:

•help improve and maintain all physical fitness determinants as well as several components of physical and mental health

•contribute to educational success

•go hand in hand with other healthy lifestyle habits

In addition, they can help foster a feeling of belonging to the community and create social networks. It is therefore important that all stakeholders work together to offer young people attractive opportunities for physical exercise.

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Exercise in elderly:

Physical activity and exercise can help you stay healthy, energetic and independent as you get older. Many adults aged 65 and over spend, on average, 10 hours or more each day sitting or lying down, making them the most sedentary age group. They’re paying a high price for their inactivity, with higher rates of falls, obesity, heart disease and early death compared with the general population. As you get older, it becomes even more important to remain active if you want to stay healthy and maintain your independence. If you don’t stay active, all the things you’ve always enjoyed doing and taken for granted may start to become that little bit harder. You may struggle to pursue simple pleasures, such as playing with the grandchildren, walking to the shops, leisure activities and meeting up with friends. You might start to get aches and pains that you never had before, and have less energy to go out. You may also be more vulnerable to falling. This can all lead to being less able to look after yourself and do the things you enjoy. The benefits for elderly individuals of regular participation in both cardiovascular and resistance-training programmes are great. Health benefits include a significant reduction in risk of coronary heart disease, diabetes mellitus and insulin resistance, hypertension and obesity as well as improvements in bone density, muscle mass, arterial compliance and energy metabolism. Additionally, increases in cardiovascular fitness (maximal oxygen consumption and endurance), muscle strength and overall functional capacity are forthcoming allowing elderly individuals to maintain their independence, increase levels of spontaneous physical activity and freely participate in activities associated with daily living. Taken together, these benefits associated with involvement in regular exercise can significantly improve the quality of life in elderly populations. It is noteworthy that the quality and quantity of exercise necessary to elicit important health benefits will differ from that needed to produce significant gains in fitness.

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Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increased their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives. Still, according to the 2010 Healthy People report by the Center for Disease Control and Prevention, 46% of people aged 65 – 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

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Ample evidence exists that physical activity intervention programmes are effective in preventing disease, injury, and other undesirable health conditions in elderly:

1. moderate to vigorous intensity aerobic endurance interventions can be effective in preventing osteoporosis, hypertension, type 2 diabetes, disability, and hospitalisation

2. resistance training, done at a moderate to high intensity, has effectiveness in preventing osteoporosis and disability

3. mobility and balance interventions are effective in preventing falls

4. interventions combining mixed types of moderate to vigorous intensity physical activity can be effective in preventing falls, physical disability, osteoporosis, hospitalisation, hypertension, and type 2 diabetes.

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In order to improve cardiorespiratory and muscular fitness, bone and functional health, reduce the risk of NCDs, depression and cognitive decline:

•Older adults should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.

•Aerobic activity should be performed in bouts of at least 10 minutes duration.

•For additional health benefits, older adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate-and vigorous-intensity activity.

•Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.

•Muscle-strengthening activities, involving major muscle groups, should be done on 2 or more days a week.

•When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

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Myth: Physical activity is for people in the “prime of life”. At old age, we don’t need to be concerned with it…

Fact: Regular physical activity has been shown to improve the functional status and quality of life of older adults. It is recommended that adults aged 65 and above do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity. Many non-communicable diseases (NCDs) prevalent in older adults can benefit from participation in regular physical activity (cardiovascular disease, osteoarthritis, osteoporosis, hypertension, falls prevention). Physical activity has also been shown to improve mental health and cognitive function in older adults and has been found to contribute to the management of disorders such as depression and anxiety. Active lifestyles often provide older persons with regular occasions to make new friendships, maintain social networks, and interact with other people of all ages. While being active from an early age can help prevent many diseases, regular movement and activity can also help relieve the disability and pain associated with these conditions. Importantly, the benefits of physical activity can be enjoyed even if regular practice starts late in life.

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Myth: The older you are the less physical activity you need.

Fact: Most people become less physically active as they age, but keeping fit is important throughout life. Regular physical activity increases older people’s ability to perform routine daily tasks and to stay independent longer. No matter what your age, you can find a physical activity program that is tailored to your particular fitness level and needs.

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Quantum of exercise:

How much exercise is enough?

The questions, “How much exercise is enough?” and “What type of exercise is best for developing and maintaining fitness?” are frequently asked. It is recognized that the term “physical fitness” is composed of a variety of characteristics included in the broad categories of cardiorespiratory fitness, body composition including regional fat distribution, muscular strength and endurance, and flexibility. In this context, fitness is defined as the ability to perform moderate-to-vigorous levels of physical activity without undue fatigue and the capability of maintaining this capacity throughout life. It is also recognized that the adaptive response to training is complex and includes peripheral, central, structural, and functional factors. Although many such variables and their adaptive responses to training have been documented, the lack of sufficient in-depth and comparative data relative to frequency, intensity, and duration of training makes them inadequate to use as models for quantifying benefits.

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The combination of frequency, intensity, and duration of chronic exercise has been found to be effective for producing a training effect. The interaction of these factors provide the overload stimulus. In general, the lower the stimulus the lower the training effect, and the greater the stimulus the greater the effect. As a result of specificity of training and the need for maintaining muscular strength and endurance, and flexibility of the major muscle groups, a well-rounded training program including aerobic and resistance training, and flexibility exercises is recommended. Although age in itself is not a limiting factor to exercise training, a more gradual approach in applying the prescription at older ages seems prudent. It has also been shown that aerobic endurance training of fewer than 2 days per week, at less than 40 % of VO2 max, and for less than 10 min duration is generally not a sufficient stimulus for developing and maintaining fitness in healthy adults. Even so, many health benefits from physical activity can be achieved at lower intensities of exercise if frequency and duration of training are increased appropriately. In this regard, physical activity can be accumulated through the day in shorter bouts of 10-min durations.

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It is apparent that physical activity is essential in the prevention of chronic disease and premature death. However, doubt remains over the optimal “volume” (frequency, duration and intensity of exercise) and the minimum volume for health benefits, in particular the effects of intensity (e.g., moderate v. vigorous) on health status. There is evidence that intensity of physical activity is inversely and linearly associated with mortality.  Early work by Paffenbarger and associates revealed that regular physical activity (expending > 2000 kcal [8400 kJ] per week) was associated with an average increase in life expectancy of 1 to 2 years by the age of 80 and that the benefits were linear even at lower levels of energy expenditure. Subsequent studies have shown that an average energy expenditure of about 1000 kcal (4200 kJ) per week is associated with a 20%–30% reduction in all-cause mortality.  Currently, most health and fitness organizations and professionals advocate a minimum volume of exercise that expends 1000 kcal (4200 kJ) per week and acknowledge the added benefits of higher energy expenditures. Recently, investigators have postulated that even lower levels of weekly energy expenditure may be associated with health benefits.  A volume of exercise that is about half of what is currently recommended may be sufficient, particularly for people who are extremely deconditioned or are frail and elderly.  Future research is required to determine whether expending as little as 500 kcal (2100 kJ) per week offers health benefits. If so, then previously sedentary people may be more likely to engage in physical activity and maintain an active lifestyle.

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The dose–response relation between physical activity and health status outlined above generally relates to cardiovascular disease and premature death from any cause. However, the same may hold true for other activity-associated health benefits. For instance, as mentioned earlier, moderately intense levels of exercise (≥ 5.5 METs for at least 40 minutes per week) and of cardiovascular fitness (> 31 mL oxygen per kilogram per minute) are effective preventive strategies against type 2 diabetes.  In patients with type 2 diabetes, walking more than 2 hours per week has also been shown to reduce the risk of premature death. With respect to cancer, a review of the literature revealed that moderate physical activity (> 4.5 METs) for about 30–60 minutes per day had a greater protective effect against colon and breast cancer than activities of low intensity. The greatest benefit for reducing the incidence of breast cancer was observed among women who engaged in 7 or more hours of moderate-to-vigorous activity per week.  Among patients with established cancer, physical activity equivalent to walking 1 or more hours per week was associated with improved survival compared with no exercise. The greatest benefit was observed among cancer survivors who performed exercise equivalent to 3–5 hours per week at an average pace. With respect to osteoporosis, the dose–response relation of physical activity is less clear. However, osteogenic adaptations appear to be load-dependent and site-specific.  Accordingly, physical activities that require impact or significant loading are therefore advocated for optimal bone health. Running distances of up to 15–20 miles (24–32 km) per week has been associated with the accrual or maintenance of bone mineral density, but longer distances may be associated with reduced bone mineral density.

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Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association: 2007:

To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes.  Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity.

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In the 2008 Physical Activity Guidelines for Americans, the national Center for Disease Control and Prevention CDC recommends at least 150 minutes of moderate-intensity aerobic activity per week for most adults. Doctors routinely encourage their patients to exercise aerobically to keep their heart healthy. And classes of all forms and stripes try to push people — if not to their limit — at least enough to make them sweat for extended periods. Even those likely to give up their fitness goals after a jog or two buy heart-rate monitors to ensure they’re wringing the most cardiovascular benefit possible from their workouts.

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Can’t find 30 minutes in your busy schedule?

That is okay, two 15-minute workouts or three 10-minute workouts can be just as effective. If that still seems like a daunting amount of time to spend exercising, don’t despair. Even just a little physical activity is better than none at all. Try starting by taking a short walk on most days, and gradually build up the length of your sessions from there. It takes about 4 weeks for an activity to become a habit so commit to maintaining your schedule for at least that long. As exercising becomes habit, you can slowly add extra minutes or try different types of activities. If you keep at it, the benefits you experience will begin to mount.

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American Heart Association Recommendations for Physical Activity in Adults 2015:

For Overall Cardiovascular Health:

•At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150

or

•At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activity

and

•Moderate- to high-intensity muscle-strengthening activity at least 2 days per week for additional health benefits.

For lowering Blood Pressure and Cholesterol

•An average 40 minutes of moderate- to vigorous-intensity aerobic activity 3 or 4 times per week

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WHO recommendation for exercise:

Children and adolescents aged 5-17years:

•Should do at least 60 minutes of moderate to vigorous-intensity physical activity daily.

•Physical activity of amounts greater than 60 minutes daily will provide additional health benefits.

•Should include activities that strengthen muscle and bone, at least 3 times per week.

Adults aged 18–64 years:

•Should do at least 150 minutes of moderate-intensity physical activity throughout the week, or do at least 75 minutes of vigorous-intensity physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity.

•For additional health benefits, adults should increase their moderate-intensity physical activity to 300 minutes per week, or equivalent.

•Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.

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The intensity of different forms of physical activity varies between people. In order to be beneficial for cardiorespiratory health, all activity should be performed in bouts of at least 10 minutes duration.

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Using a pedometer:

A pedometer is a small device, usually worn on a belt, that counts the number of steps that you have taken, by sensing the motion of your hips. Many people find it a useful tool to help with motivation and monitoring when trying to increase their physical activity levels. Wearing a pedometer on an average day can give you a baseline for the number of steps that you generally take. A very sedentary person will take between 1,000-3,000 steps per day. However, most people are in the range of 4,000-6,000 steps per day. About 30 minutes of brisk walking should be around 3,000 steps. So, a good target could be to add 3,000 steps to your baseline number and aim for this. You may want gradually to build up by increments of 500-1,000 steps. The magic number to aim for in the end is at least 10,000 steps per day. It is thought that if you can manage this, it will help to keep you fit and healthy.

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Walking:

Behavior change affects our private life and relationships. Exercise therapy takes place in the wrong setting because you have to attend a gym as if you are going to a physician—often things you would like to avoid. On the other hand, walking steps is something that we do every day and in all situations of our life; it is already part of our daily lifestyle. Walking is a refreshing alternative to complicated aerobic routines and overpriced gym memberships. It is free, enjoyable and already a part of everyday life. All you need to do is correct your technique, walk faster and for longer and you will lose weight. Walking is one of the best forms of physical activity – it is low impact (so does not put stress on the joints), weight-bearing (so it can improve bone density) and a 60kg individual walking briskly will burn about 300kcal an hour, so it can assist with weight loss. Additional benefits include stress reduction and improved sleep. And the long-term health benefits of walking are startling.

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Evolution has prepared us to “walk.” We are not “exercise” machines, but 10,000 years ago we had to walk probably >20,000 steps/day for our daily survival. What is the situation today? We usually walk <5,000 steps/day, burn less energy, gain visceral adiposity, and accumulate chronic diseases like diabetes. Therefore, increasing the daily number of steps, supported by a group-based program, could be the most adequate intervention to increase physical activity and to improve glycemic control for all of our patients with diabetes and many other diseases. We can extrapolate that walking 10,000 steps/day from the age of 25 years may prevent many chronic diseases. Yates and co-workers have shown that a pragmatic structured education program that incorporates pedometer use is effective for improving glucose tolerance in subjects with impaired glucose tolerance. Interestingly, walking 1,000 steps more than your average per day—for a diabetic patient—reduces postprandial blood glucose by1.6 mmol/L over a period of 2 years. This has the same effect on postprandial blood glucose as 1,000 mg metformin and can help to reduce the daily medication in diabetes treatment and associated therapies such as blood pressure medication or lipid-lowering drugs. There is much evidence of the benefits of walking. Scientists from Lawrence Berkeley National Laboratory, Life Science Division in Berkeley, California reported in the journal Arteriosclerosis, Thrombosis and Vascular Biology that brisk walking is as effective as running in reducing a person’s risk of hypertension (high blood pressure), high cholesterol and diabetes. Scientists at the University of Pittsburgh recently revealed that overweight people who walked briskly for 30 to 60 minutes a day lost weight even if they didn’t change any other lifestyle habits. Another American study found that people who walked for at least four hours a week gained less weight (an average nine pounds less) than couch potatoes as they got older. Researchers at the University of Colorado found that regular walking helped to prevent peripheral artery disease (which impairs blood flow in the legs and causes leg pain in one-fifth of elderly people). Researchers at the University of Massachusetts medical school found that people who walked every day had 25 percent fewer colds than those who were sedentary.

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It seems that the most simple exercise, walking, could be the best way to improve mental power. People who walk for fitness have improved communication between the various regions of the brain. This is caused by enhanced neural connectivity. This in turn improves skills such as planning, prioritizing, strategizing, and multitasking. The great thing about walking is that nearly everyone can do it, no matter their age or physical condition. It requires no equipment, and most people find it enjoyable so are likely to stick with it. Many people report that their daily walk “clears their head” and helps them think clearly. Walking seems to be the perfect kind of exercise for your brain. Because walking is a weight-bearing exercise, it can also help prevent the bone disease osteoporosis. Bones are like muscles in the way that they get stronger and denser the more demands you place on them. The pull of a muscle against a bone, together with the force of gravity when you walk, will stress the bone — which responds by stimulating tissue growth and renewal.  Best of all, walking makes you feel good about yourself. For people suffering from depression, walking three to four times a week for 30 minutes has been shown to enhance their mood. Even if a 20 minute power walk at lunchtime is all you manage, after six weeks it could be comparable to a course of psychotherapy, psychologists at the University of Illinois found.

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How much, how often?

Health experts recommend that we should walk 10,000 steps a day (about five miles) to stay healthy, yet most Britons walk only 4,500 steps. You would probably need to tot up at least 16,000 steps a day to lose weight.

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Brisk Walking means Moderate Intensity aerobic exercise:

Walking provides a low-intensity workout that does not elevate your heart rate as high or use as much energy as higher-intensity forms of exercise. In order to improve your cardiovascular health, you must exercise at an intensity that increases your heart rate and causes you to breathe more rapidly than you normally do. Walking at 3 miles per hour can provide a moderate-intensity workout, but not a vigorous-intensity workout. Brisk walking actually refers to your exertion. For your walking pace to be brisk, you need to be breathing harder than usual. While you should still be able to speak in full sentences, you shouldn’t be able to sing. The moderate intensity zone is defined by the CDC as being from 50% to 70% of their maximum heart rate. This varies by age.

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How fast is Brisk Walking?

Rule of Thumb:

The Center for Disease Control and Prevention (CDC) says that brisk walking is at a pace of three miles per hour or more or roughly 20 minutes per mile. That comes to an average of about 100 steps per minute. That equates to about five kilometers per hour or 12 minutes per kilometre. However, fitter people still will not be in a moderately intense exercise zone at that pace. A pace of 15 minutes per mile, or four miles per hour, is more likely to put fitter people into a moderately intense exercise zone. That equates to 9 minutes, 15 seconds per kilometer or 6.5 kilometers per hour. Walking speedometers and apps may give a readout in either minutes per mile/kilometers per mile or in miles per hour/kilometers per hour.

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How many steps would make one mile?

The answer to this question varies depending on the size of your stride. A step for a 7ft tall runner will be very much longer than that of a 4ft tall dwarf enjoying a casual walk. A widely quoted estimate of stride length is 42% of height, although further research shows that ratio is only moderately accurate. However, it is commonly said that, on average, 2,000 walking steps make up a mile. This means that 10,000 steps converts to around 5 miles, with average stride length. If you want the figure for one kilometer, you’re looking at 1,250 walking steps.

A rough average for walking steps:

1 mile = 2,000 steps

1 km = 1,250 steps

10,000 steps = 5 miles.

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For jogging or running:

Jogging/running 1 mile = 4,000 steps

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Is walking just as good as running?

Walking may seem like more of a mode of transport than a form of exercise, but it really is one of the best things you can do for your body, your beauty and your long-term health. While you thought you were just getting from here to there, those steps were improving your cardiovascular strength, strengthening your muscles (which means more fat-burning power) and decreasing your chances of disease.  A May 2013 study by researchers in the Life Science Division at Lawrence Berkeley National Laboratory looked at data from 33,000 runners and nearly 16,000 walkers to compare the relative health benefits of each activity. From the outside it might seem like running – which is considered a vigorous intensity exercise – must be better for you than walking, a moderate form of exercise. But the results bore out differently, with walking taking a slight edge in the end. Both walking and running had positive effects. When the researchers checked in with participants six years after the start of the study, they found that running significantly reduced the risk of high blood pressure (by 4.2 percent), high cholesterol (4.3 percent), diabetes (12.1 percent) and cardiovascular heart disease (4.5 percent), for every MET h/d, which is a standard measure of metabolic energy expenditure. Participants who walked regularly saw even better results. Walking decreased risk by 7.2 percent for high blood pressure, 7 percent for high cholesterol, 12.3 percent for diabetes and 9.3 percent for cardiovascular heart disease. The more someone walked or ran, the greater the benefit.  The runners and walkers had to expend the same energy to get the same benefits. Equivalent energy expenditures by moderate walking and vigorous running exercise produced similar risk reductions for hypertension, hypercholesterolemia, diabetes mellitus, and possibly CHD. That means you’d have to walk longer than you’d have to run for the same effect.

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Which is right for you?

Walking stresses your joints considerably less than running and many people find it easier to incorporate a regular walking regime into their lives, than other forms of exercise. If you have a history of lower limb joint injuries then you may benefit more from a brisk walking programme than from running. If weight loss is your goal, research shows that a brisk walk gives similar results to a gentle jog over the same distant. Running at a fast pace however, burns more calories. Running is a great choice of exercise for a person with finer bone structure and a lighter build. Conversely, if you have a heavier build then you would probably be better to follow a walking or interval training programme. The impact of running on your joints can be more than three times your body weight, with every step being triple the impact of walking, so it’s important to train your body to get used to the jarring. And a decent pair of walking or running shoes is a must.

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Are there times when is walking better than running?

1. Running can damage your heart. Read over-exercise later on in the article. In the journal Circulation, researchers performed echocardiographic measurements of cardiac function in 60 recreational runners before and 20 minutes after the 2004 and 2005 Boston Marathon. What they found was that before the race, none of the runners had elevated serum markers for cardiac stress. After the race, 36 runners, or 60 percent, had elevated markers of a certain triplet of proteins called troponin. Troponin is a major component of cardiac muscle but elevated levels of subtypes of these proteins can lead to cardiovascular damage. If that’s not enough to discourage a long-distance run, consider that the researchers also discovered that 24 runners (40 percent) developed signs of myocardial necrosis, irreversible damage to heart muscle cells. The researchers also discovered at least 10 studies from 2004 to 2006 alone that documented increases in myocardial damage; there is no evidence that brisk walking can destroy heart muscle or cells.

2. Running may cause osteoarthritis. It seems that at a certain “dose,” as researchers put it in a study published in the Journal of the American Osteopathic Association, running does not cause osteoarthritis, but after a certain point, reduced risk of disease is offset by an increased risk of injury and osteoarthritis. If you’ve been running for a long time and have had injuries — and most runners have — then you’re more likely to “to deplete the joint of the lubricating glycoproteins, disrupt the collagen network, slowly wear away the cartilage, and cause numerous microfractures in the underlying bones.”

3. Running can also damage cartilage. Although authors of a study published in the American Journal of Sports Medicine state that there is continuing controversy as to whether long-distance running results in irreversible articular cartilage damage, this specific study concluded that through the use of magnetic resonance imaging (MRI), biochemical changes in articular cartilage remained elevated after three months of reduced activity. The patellofemoral joint and medial compartment of the knee showed the greatest wear and tear, suggesting higher risk for degeneration.

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No time for a workout, try micro-workout.

Micro-exercise (micro-workouts):

As the name suggests, micro workouts are small, quick workouts that can be done anytime, anywhere. A micro workout doesn’t last longer than ten minutes. A usual micro-workout is 7 minutes long. From brisk walks to jumping jacks, you can use any exercise that can take your heart up.  Simple, effective and time-efficient, micro workouts help overcome the constraints of time and space. These are ideal for those who are hard-pressed for time. The trend is fast catching up. Lunch time classes and drop-in classes in gyms are springing up. Also, corporate groups are providing micro workouts as part of their workplace wellness. People who lack time should go for it. The recommended 150-minute figure is the equivalent of 21 micro workouts a week. The focus is kept on the speed and intensity of the exercises while working out. The rule is simple — the faster you go the better results you get. The concept has come from Tabata training practiced by Japanese athletes. The idea is to take the heart rate up for a few seconds and then cool down for another few, and repeating the same for a couple of minutes. The variation of heart rate makes the body burn more fat for energy. These workouts enhance the muscular as well as cardiovascular abilities.  The calorie burn in micro workouts is not as much as in the normal workouts, but it boosts the metabolism. You only burn 40-50 calories in a four minute micro workout. But it enhances your calorie burning capacity through-out the day. So your body can burn 400-500 calories over the next 5-6 hours. There’s a catch. These workouts are short, but not easy. Since they are done at high speed and intensity, you need to push yourself harder than in a normal workout. You push your body with all the power your body can possibly have so that each and every muscle of your body gets worked up, which means you may end up with a heavy head, which is the ideal level of a micro workout session. You must do it so fast and so hard that by the end of it you feel totally wiped out. I would call is fast workout rather than micro workout. It is micro in time but fast in intensity. This is pretty impossible to sustain for most people. Moreover, for the best results, you need to do it 3-4 times in a day. Micro workouts help you move more and beat the negative impact of excessive sitting on the body. So you need to spread these workouts throughout the day. These workouts can’t be used as a substitute to normal workouts. But as the saying goes, something is better than nothing.

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Exercise in women:

Reasons for physical inactivity in women:

Physical inactivity is generally more prevalent among girls and women than their male counterparts. Many factors hinder the participation of women in physical activity and their access to health care:

•The income of women is often lower than that of men and therefore the costs of access to physical activity facilities may be a barrier.

•Agreement may be required from senior members of the household who control household resources before a woman can engage in physical activity.

•Women often have a workload in the home and care-giving roles for other family members which may limit the time available for them to engage in physical activity.

•Women who have limited mobility may be unable to travel to health centres or physical activity facilities.

•Cultural expectations may restrict the participation of women in certain forms of physical activity.

Social inequality, poverty and inequitable access to resources, including health care, result in a high burden of noncommunicable diseases (NCDs) among women worldwide. Although women generally tend to live longer with NCDs than men, they are often in poor health. Regular physical activity can improve women’s’ health and help prevent many of the diseases and conditions that are major causes of death and disability for women around the world. Many women suffer from disease processes that are associated with inadequate participation in physical activity:

•Cardiovascular diseases account for one-third of deaths among women around the world and half of all deaths in women over 50 years old in developing countries.

•Diabetes affects more than 70 million women in the world and its prevalence is projected to double by 2025.

•Osteoporosis is a disease in which bones become fragile and more likely to break and is most prevalent in post-menopausal women.

•Breast cancer is the mostly commonly diagnosed cancer in women.

Physical activity has also been associated with improved psychological health by reducing levels of stress, anxiety and depression. This is particularly important for women who demonstrate an incidence of depression that is reported to be almost double that of men in both developed and developing countries. It has also been suggested that physical activity can contribute to building self-esteem and confidence and can provide a vehicle for social integration and equality for women in society.

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Exercise and menses:

Too little exercise:

If you have a sedentary lifestyle and your daily routine includes little or no exercise, you are likely to experience painful, long and irregular menstruation cycles. You are also more likely to have irregular periods if you are overweight or obese.

Moderate exercise:

Research shows that menstruating females who are doing moderate exercises on a regular basis usually have less extreme and shorter cycles. Simply put, regular exercising will lead to regular menstruation. Moderate physical activities might actually improve a number of the severe side effects that women experience during menstruation. These include side effects such as uterine cramping, back pain, nausea and vomiting.

Over exercising:

Too much exercise can put excessive amount of stress on your body to produce the regular hormones that is needed to complete a menstrual cycle. Menstruation is important because it is connected to reproduction. When you exercise, your body will go in a survival mode and might shut down unnecessary functions such as menstruation to help save energy and keep your body going in its current condition. Your body will actually hold unto every ounce of energy that it can to allow the vital functions to perform properly. It is also important to know that intense physical activity and a lower caloric intake can cause your period to stop. This condition is called amenorrhea and it occurs more frequently in menstruating females who take part in extreme fitness, distance running or bodybuilding, but it can also develop in persons who participate in various other sports which emphasize slimness, like figure skating, gymnastics and ballet.  In general, women who suffer from amenorrhea experiences a continuous energy deficit that ultimately leads to the hypothalamus to suppress the discharge of hormones which regulates the ovarian function.  If your ovaries fail to discharge an egg for fertilization, this will put a stop to your period. A woman’s body is expected to menstruate until pregnancy or menopause, so you should take care of yourself to avoid amenorrhea. Furthermore, it is important to menstruate every month because this is the time when the uterine lining sheds. Studies show that most women experience a total absence of menstruation whenever their body fat levels drop below twenty percent. Besides that, women with twenty to twenty-five percent of body fat are more likely to have problems with irregular menstruation.

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Exercise and pregnancy:

According to international guidelines, exercise with moderate intensity is safe pregnancy. Moderate exercise in healthy pregnant women does not increase the risk for miscarriage, preterm labor, or rupture of the membrane. Healthy women with normal pregnancies should exercise at least three times a week, being careful to warm up, cool down, and drink plenty of liquids. Many prenatal calisthenics programs are available.

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The pregnant woman experiences many physiological and anatomical changes, particularly during the second half of the pregnancy. Some of these changes, including postural changes, a shift in the centre of gravity, weight gain and hormonal changes, can increase a pregnant woman’s susceptibility to injury. Moreover, balance and co-ordination skills can be affected, and activities requiring these skills may become more difficult for a pregnant woman, and can be associated with increased risk of sustaining injury. The release of the hormone relaxin causes all joints, particularly the pelvic joints, to become more mobile. Instability and injury to the sacroiliac and pubic symphis joints can potentially arise.

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Physical exercise has gained increasing popularity among women in the fertile age, and as a result, many women ask for medical advice on whether or not they can continue to exercise throughout their pregnancy. Guidelines in countries such as the USA, Great Britain and Denmark are currently recommending physical activity during pregnancy at a level similar to that of the nonpregnant population. Physical exercise during pregnancy is known to have beneficial effects on numerous health outcomes, including a decreased risk of pre-eclampsia and gestational diabetes, but whether or not such effects apply to the health of the fetus remains unclear. The effect of leisure time physical activity during pregnancy should therefore be investigated to make antenatal care counselling on this subject as evidence based as possible. Pathways which have been suggested to mediate a potential effect of maternal exercise on fetal health include: (1) reduction of placental blood flow due to redistribution of blood to the working muscles, (2) exercise-induced hyperthermia, (3) exercise-induced release of hormones stimulating uterine contractility, and (4) fetal hypoglycaemia as a result of increased glucose uptake in exercising muscles. All of these physical responses may potentially have adverse effects on pregnancy outcome. Several animal experiments have given support to these hypotheses, while human studies are less conclusive. Only few studies have specifically addressed the association between exercise during pregnancy and miscarriage. In the existing body of literature, exercise during pregnancy has generally not been associated with miscarriage, and one case–control study has even reported a protective effect of exercise during pregnancy. In contrast, Hjollund et al. found an increased risk of early miscarriage among women who reported a high physical strain around the time of implantation of the embryo. Furthermore, lay people have tried to use excessive physical exercise as abortificant, and older literature mentions physical activity (e.g. jumping, running, and horseback riding) as a cause of miscarriage. Some studies have demonstrated that women who exercise intensely more than three times a week during the third trimester of pregnancy give birth to significantly small birth weight babies. Exercise of light intensity, three times a week or less, is therefore recommended.

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The following are specific exercises that may benefit the pregnant woman:

•Swimming and water aerobics may be the best option for most pregnant women. Water exercises involve no impact, overheating is unlikely, and swimming face down promotes optimum blood flow to the uterus.

•Performing yoga exercises under the guidance of informed instructors can be very helpful.

•Walking is also beneficial.

To strengthen pelvic muscles, women should perform Kegel exercises at least six times a day. This involves contracting the muscles around the vagina and urethra for three seconds 12 – 15 times in a row.

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The following precautions are generally recommended for pregnant women who exercise:

•Fit women who have exercised regularly before pregnancy may work out intensely as long as the doctor approves and no discomfort occurs. However, excessive exercise can cause undernourishment of the fetus.

•As a rule for previously sedentary, low-risk expectant mothers, the pulse rate should not exceed 70 – 75% of the maximum heart rate, or more than 150 beats per minute. Any sedentary expectant mother should check with her doctor before starting an exercise program.

•Vigorous exercise may improve the chances for a timely delivery. All pregnant women, however, should avoid high-impact, jerky, and jarring exercises, such as aerobic dancing, which can weaken the pelvic floor muscles that support the uterus.

•During exercise, women should monitor their temperature to avoid overheating, a side effect that can damage the fetus. (Pregnant women should also not use hot tubs or steam baths, which can cause fetal damage and miscarriage.)

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Physical exercise during pregnancy: a systematic review of 2012.

Exercises during pregnancy are associated with higher cardiorespiratory fitness, prevention of urinary incontinence and low back pain, reduced symptoms of depression, gestational weight gain control, and for cases of gestational diabetes, reduced number of women who required insulin. There is no association with reduction in birth weight or preterm birth rate. The type of exercise shows no difference on results, and its intensity should be mild or moderate for previous sedentary women and moderate to high for active women. The exercise recommendations still are based on the current guidelines on moderate-intensity, low-impact, aerobic exercise at least three times a week. Yet, new guidelines propose increasing weekly physical-activity expenditure while incorporating vigorous exercise and adding light strength training to the exercise routine of healthy pregnant women. In the case of other chronic diseases like hypertension, there are still few data, and therefore more studies should be performed to assess the safety of the intervention.

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When Mom exercises in Pregnancy, her Baby’s heart benefits: 2015 study:

Previous research has indicated that exercise in the first trimester, when the placenta is formed, helps forge extra blood vessels so that there is more opportunity to exchange nutrients between mom and baby. Linda May, an exercise physiologist and anatomist at Kansas City University of Medicine and Biosciences, figured there were bound to be sustained benefits for the baby too. May and colleagues collected noninvasive fetal heart measurements from 66 fetuses when their mothers reached 28, 32 and 36 weeks of a typical 40-week pregnancy. Some of the mothers engaged in moderate to vigorous aerobic activity for 30 minutes at least three times a week; others didn’t exercise.  Researchers then assessed fetal heart rate and heart rate variability, which is the span between beats. Heart rate variability is indicative of heart health, which is associated with better overall health: people with increased variability are exercisers, and their hearts function more efficiently; those with decreased variability may be cardiac patients or, at the least, couch potatoes. At 32 weeks, researchers started to see changes in heart response in the fetuses of the exercising moms. By 36 weeks, they noted what May calls a “big, significant change” — lower heart rate and increased heart rate variability. When researchers analyzed the frequency with which Mom exercised, they found that the more activity, the lower the fetal heart rate and the higher the heart rate variability.

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Is physical activity safe for all pregnant women?

No. Not every woman should exercise during pregnancy.

Don’t exercise if you have:

•Heart problems that affect blood flow

•Preterm labor. Preterm labor is labor that happens too early, before 37 weeks of pregnancy.

•An incompetent cervix. This is a cervix that opens too early, before the baby is full term.

•Lung disease

•A pregnancy with twins, triplets or more (also called multiples). Being pregnant with multiples increases your chances for having preterm labor.

•Vaginal bleeding during the second or third trimesters (from 4 months of pregnancy on) that doesn’t go away

•Ruptured membranes (when your water breaks)

•Preeclampsia. This is a condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs like her kidneys and liver, may not be working properly. Some of these signs include having protein in the urine, changes in vision and severe headache.

•Placenta previa. This is when the placenta sits low in the uterus and covers all or part of the cervix. The placenta supplies the baby with food and oxygen through the umbilical cord. The cervix is the opening to the uterus that sits at the top of the vagina.

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According to the American College of Sports Medicine, to maintain safety for you and your child, do not continue intense exercise if you have vaginal bleeding, severe chest pain, calf swelling, decreased fetal movement and amniotic fluid leakage. Refrain from exercise if you have orthopedic limitations, are a heavy smoker, extremely underweight, morbidly obese, have heart disease, have lung disease, are at risk for premature labor or have pregnancy-induced hypertension.

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Activities that should be avoided during pregnancy include:

•Scuba diving

•Water skiing

•Martial arts

•Gymnastics

•Trampolining

•Weight lifting

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Note: Strenuous exercise may affect the flavor of breast milk for a short time afterward. Nursing mothers who engage in such activity might want to wait about an hour after exercising before they feed their infant.

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Physiology of exercise:

Exercise physiology is the physiology of physical exercise, that is, study of the acute responses and chronic adaptations to a wide range of exercise conditions. Exercise represents one the highest levels of extreme stresses to which the body can be exposed. For example, in a person who has an extremely high fever approaching the level of lethality, the body metabolism increases to approximately 100% above normal; by comparison, the metabolism of the body during a marathon race increases to 2000% above normal.

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Energy expenditure:

Humans have a high capacity to expend energy for many hours during sustained exertion. For example, one individual cycling at a speed of 26.4 km/h (16.4 mph) through 8,204 km (5,098 mi) over 50 consecutive days expended a total of 1,145 MJ (273,850 kcal; 273,850 dieter calories) with an average power output of 182.5 W. Skeletal muscle burns 90 mg (5 mmol) of glucose each minute during continuous activity (such as when repetitively extending the human knee),  generating ≈24 W of mechanical energy, and since muscle energy conversion is only 22–26% efficient, ≈76 W of heat energy. Resting skeletal muscle has a resting metabolic rate of 0.63 W/kg making a 160 fold difference between the energy consumption of inactive and active muscles. For short duration muscular exertion, energy expenditure can be far greater: an adult human male when jumping up from a squat can mechanically generate 314 W/kg. Such rapid movement can generate twice this amount in nonhuman animals such as bonobos, and in some small lizards. This energy expenditure is very large compared to the resting metabolic rate of the adult human body. This rate varies somewhat with size, gender and age but is typically between 45 W and 85 W. Total energy expenditure (TEE) due to muscular expended energy is much higher and depends upon the average level of physical work and exercise done during a day. Thus exercise, particularly if sustained for very long periods, dominates the energy metabolism of the body. Physical activity energy expenditure correlates strongly with the gender, age, weight, heart rate, and VO2 max of an individual, during physical activity.

Sex Differences:

In general, the exercise-related measurements established for women follow the same general principles as those established for men, except for the quantitative differences caused by differences in body size, body composition, and levels of testosterone. In women, the values of muscle strength, pulmonary ventilation, and cardiac output (all variables related with muscle mass) are generally 60-75% of the exercise physiology values recorded in men. When measured in terms of strength per square centimeter, the female muscle can achieve the same force of contraction as that of a male.

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Muscle Metabolic Systems during Exercise:

Exercise and ATP:

For your muscles — in fact, for every cell in your body — the source of energy that keeps everything going is called ATP. Adenosine triphosphate (ATP) is the biochemical way to store and use energy. The entire reaction that turns ATP into energy is a bit complicated, but here is a good summary:

•Chemically, ATP is an adenine nucleotide bound to three phosphates.

•There is a lot of energy stored in the bond between the second and third phosphate groups that can be used to fuel chemical reactions.

•When a cell needs energy, it breaks this bond to form adenosine diphosphate (ADP) and a free phosphate molecule.

•In some instances, the second phosphate group can also be broken to form adenosine monophosphate (AMP).

•When the cell has excess energy, it stores this energy by forming ATP from ADP and phosphate.

ATP is required for the biochemical reactions involved in any muscle contraction. As the work of the muscle increases, more and more ATP gets consumed and must be replaced in order for the muscle to keep moving. Because ATP is so important, the body has several different systems to create ATP. These systems work together in phases. The interesting thing is that different forms of exercise use different systems, so a sprinter is getting ATP in a completely different way from a marathon runner!

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ATP comes from three different biochemical systems in the muscle, in this order:

1. phosphagen system

2 .glycogen-lactic acid system

3. aerobic respiration

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Exercise and the Phosphagen System:

A muscle cell has some amount of ATP floating around that it can use immediately, but not very much — only enough to last for about three seconds. To replenish the ATP levels quickly, muscle cells contain a high-energy phosphate compound called creatine phosphate. The phosphate group is removed from creatine phosphate by an enzyme called creatine kinase, and is transferred to ADP to form ATP. The cell turns ATP into ADP, and the phosphagen rapidly turns the ADP back into ATP. As the muscle continues to work, the creatine phosphate levels begin to decrease. Together, the ATP levels and creatine phosphate levels are called the phosphagen system. The phosphagen system can supply the energy needs of working muscle at a high rate, but only for 8 to 10 seconds.

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Exercise and the Glycogen-Lactic Acid System:

Muscles also have big reserves of a complex carbohydrate called glycogen. Glycogen is a chain of glucose molecules. A cell splits glycogen into glucose. Then the cell uses anaerobic metabolism (anaerobic means “without oxygen”) to make ATP and a byproduct called lactic acid from the glucose. For this system, each glucose molecule is split into 2 pyruvic acid molecules, and energy is released to form several ATP molecules, providing the extra energy. Then, the pyruvic acid partially breaks down further to produce lactic acid. About 12 chemical reactions take place to make ATP under this process, so it supplies ATP at a slower rate than the phosphagen system. The system can still act rapidly and produce enough ATP to last about 90 seconds. This system does not need oxygen, which is handy because it takes the heart and lungs some time to get their act together. It is also handy because the rapidly contracting muscle squeezes off its own blood vessels, depriving itself of oxygen-rich blood.

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Exercise and Aerobic Respiration:

By two minutes of exercise, the body responds to supply working muscles with oxygen. When oxygen is present, glucose can be completely broken down into carbon dioxide and water in a process called aerobic respiration. The aerobic system in the body is used for sports that require an extensive and enduring expenditure of energy, such as a marathon race. Endurance sports absolutely require aerobic energy. A large amount of ATP must be provided to muscles to sustain the muscle power needed to perform such events without an excessive production of lactic acid. This can only be accomplished when oxygen in the body is used to break down the pyruvic acid (that was produced anaerobically) into carbon dioxide, water, and energy by way of a very complex series of reactions known as the citric acid cycle. This cycle supports muscle usage for as long as the nutrients in the body last. The glucose can come from three different places:

•remaining glycogen supplies in the muscles

•breakdown of the liver’s glycogen into glucose, which gets to working muscle through the bloodstream

•absorption of glucose from food in the intestine, which gets to working muscle through the bloodstream

Aerobic respiration can also use fatty acids from fat reserves in muscle and the body to produce ATP. In extreme cases (like starvation), proteins can also be broken down into amino acids and used to make ATP. Aerobic respiration would use carbohydrates first, then fats and finally proteins, if necessary. Aerobic respiration takes even more chemical reactions to produce ATP than either of the above systems. Aerobic respiration produces ATP at the slowest rate of the three systems, but it can continue to supply ATP for several hours or longer, so long as the fuel supply lasts.

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Three energy systems in muscles:

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Post-exercise Recovery:

Oxygen debt:

During muscular exercise, blood vessels in muscles dilate and blood flow is increased in order to increase the available oxygen supply. Up to a point, the available oxygen is sufficient to meet the energy needs of the body. However, when muscular exertion is very great, oxygen cannot be supplied to muscle fibers fast enough, and the aerobic breakdown of pyruvic acid cannot produce all the ATP required for further muscle contraction.  During such periods, additional ATP is generated by anaerobic glycolysis. In the process, most of the pyruvic acid produced is converted to lactic acid. Although approximately 80% of the lactic acid diffuses from the skeletal muscles and is transported to the liver for conversion back to glucose or glycogen, some lactic acid accumulates in muscle tissue, making muscle contraction painful and causing fatigue. Ultimately, once adequate oxygen is available, lactic acid must be catabolized completely into carbon dioxide and water.  After exercise has stopped, extra oxygen is required to metabolize lactic acid; to replenish ATP, phosphocreatine, and glycogen; and to replace (“pay back”) any oxygen that has been borrowed from hemoglobin, myoglobin (an iron-containing substance similar to hemoglobin that is found in muscle fibers), air in the lungs, and body fluids. The additional oxygen that must be taken into the body after vigorous exercise to restore all systems to their normal states is called oxygen debt. The debt is paid back by labored breathing that continues after exercise has stopped. Thus, the accumulation of lactic acid causes hard breathing and sufficient discomfort to stop muscle activity until homeostasis is restored.

Recovery of muscle glycogen post-exercise:

Eventually, muscle glycogen must also be restored. Restoration of muscle glycogen is accomplished through diet and may take several days, depending on the intensity of exercise.

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Pulmonary Physiology during Exercise:

The purpose of respiration is to provide oxygen to the tissues and to remove carbon dioxide from the tissues. To accomplish this, 4 major events must be regulated, as follows:

• Pulmonary ventilation

• Diffusion of oxygen and carbon dioxide between the alveoli and the blood

• Transport of oxygen and carbon dioxide in the blood and body fluids and to and from the cells

• Regulation of ventilation and other aspects of respiration

Exercise causes these factors to change, but the body is designed to maintain homeostasis. When one goes from a state of rest to a state of maximal intensity of exercise, oxygen consumption, carbon dioxide formation, and total pulmonary and alveolar ventilation increase by approximately 20-fold. A linear relationship exists between oxygen consumption and ventilation. At maximal exercise, pulmonary ventilation is 100-110 L/min, whereas maximal breathing capacity is 150-170 L/min. Thus, the maximal breathing capacity is approximately 50% greater than the actual pulmonary ventilation during maximal exercise. This extra ventilation provides an element of safety that can be called on if the situation demands it (e.g., at high altitudes, under hot conditions, abnormality in the respiratory system). Therefore, the respiratory system itself is not usually the most limiting factor in the delivery of oxygen to the muscles during maximal muscle aerobic metabolism.

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Cardiovascular System and Exercise:

Regular exercise makes the cardiovascular system more efficient at pumping blood and delivering oxygen to the exercise muscles. Exercises increase some of the different components of the cardiovascular system, such as stroke volume (SV), heart rate (HR), cardiac output, systolic blood pressure (BP), and mean arterial pressure. A greater percentage of the cardiac output goes to the exercising muscles. At rest, muscles receive approximately 20% of the total blood flow, but during exercise, the blood flow to muscles increases to 80-85%. To meet the metabolic demands of skeletal muscle during exercise, 2 major adjustments to blood flow must occur. First, cardiac output from the heart must increase. Second, blood flow from inactive organs and tissues must be redistributed to active skeletal muscle. Generally, the longer the duration of exercise, the greater the role the cardiovascular system plays in metabolism and performance during the exercise bout. An example would be the 100-meter sprint (little or no cardiovascular involvement) versus a marathon (maximal cardiovascular involvement).

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Changes in oxygen delivery to muscle during exercise:

• BP increases as exercise intensity increases, rising from approximately 120 mm Hg to approximately 200 mm Hg.

• SV increases during exercise until 40% of VO2max (maximum oxygen uptake level) is reached, rising from approximately 80 mL/beat to approximately 120 mL/beat.

• HR increases with intensity until VO2max is reached, rising from approximately 70 beats per minute to approximately 200 beats per minute.

• Cardiac output increases with intensity until VO2max is reached, rising from approximately 5 L/min to approximately 25-30 L/min.

The arterial-venous oxygen difference is the amount of oxygen extracted from the blood as it passes through the capillary bed. This difference rises from approximately 4 mL of oxygen per 100 mL of blood at rest to approximately 18 mL of oxygen per 100 mL of blood during high-intensity aerobic exercise.

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Redistribution of blood flow during exercise:

At rest, 15-20% of blood goes to skeletal muscle; during exercise, this amount increases to 80-85%. The percentage of blood to the brain decreases, but the absolute amount increases. The same percentage of blood goes to cardiac muscle, but the absolute amount increases. Blood flow to visceral tissues and inactive skeletal muscle reduces. In addition, the cutaneous blood flow initially decreases, but it later increases during the course of exercise. The redistribution of the blood is brought about by several mechanisms. During exercise, generalized vasodilatation occurs because of the accumulation of vasodilatory metabolites. As ATP gets used up in working muscle, the muscle produces several metabolic by-products (such as adenosine, hydrogen ions and carbon dioxide). These by-products leave the muscle cells and cause the capillaries (small, thin-walled blood vessels) within the muscle to expand or dilate (vasodilation). The increased blood flow delivers more oxygenated blood to the working muscle. This leads to a decrease in the peripheral resistance, which, in turn, elicits a strong increase in the sympathetic activity through the activation of baroreceptors. The increase in sympathetic activity leads to vasoconstriction in the visceral organs, whereas the vasodilatation predominates in the blood vessels of the muscles and the coronary circulation because of the local vasodilatory metabolites. The cutaneous blood vessels initially respond to the sympathetic activity by vasoconstriction. As the exercise continues, temperature reflexes are activated and cause cutaneous vasodilatation to dissipate the heat produced by the muscle activity, resulting in an increase in the cutaneous blood flow.

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Regulation of blood flow at the local level:

The local blood flow is controlled by chemical factors, metabolites, paracrines, physical factors such as heat or cold, stretch effects on endothelial membrane, active hyperemia, and reactive hyperemia. The paracrine regulation is mainly regulated by nitric oxide, histamine release, and prostacyclin. Nitric oxide diffuses to smooth muscle and causes vasodilation by reducing calcium entry into smooth muscle.

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Haemoglobin’s Role in Exercise:

Your body has increased the flow of oxygen-rich blood to your muscles, but your muscles still need to get the oxygen out of the blood. An exchange of oxygen and carbon dioxide is the key to this. A protein called hemoglobin, which is found in red blood cells, carries most of the oxygen in the blood. As you exercise, though, the metabolic activity is high, more acids (hydrogen ions, lactic acid) are produced and the local pH is lower than normal. The low pH reduces the attraction between oxygen and hemoglobin and causes the hemoglobin to release more oxygen than usual. This increases the oxygen delivered to the muscle. Your exercising body is using energy and producing waste, such as lactic acid, carbon dioxide, adenosine and hydrogen ions. Your muscles need to dump these metabolic wastes to continue exercise. All that extra blood that is flowing to the muscles and bringing more oxygen can also take the wastes away. The hemoglobin in the blood will carry away the carbon dioxide, for example.

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Athlete’s heart:

The heart undergoes certain morphologic changes in response to chronic exercise, commonly seen via echocardiography. These morphologic changes define what is commonly referred to as an “athletic heart.” Athletic heart syndrome is characterized by hypertrophy of the myocardium (i.e., an increase in the mass of the myocardium). Although the hypertrophy in athlete’s heart is morphologically similar to that seen in patients with hypertension, several important differences exist. In contrast to the hypertension-induced hypertrophy, the hypertrophy in the athletic heart is noted in absence of any diastolic dysfunction, with a normal isovolumetric relaxation time, with no decrease in the peak rate of left ventricular filling, and with no decrease in the peak rate of left ventricular cavity enlargement and wall thinning. Because the wall stress in the athlete’s heart is normal, sometimes the hypertrophy seems to be disproportionate to the level of resting BP. In addition, the rate of decline in the left ventricular hypertrophy and mass is much more rapid when the training is stopped compared with the regression in the same parameters in treated hypertension. On average, the decline in these parameters is seen 3 weeks after stopping exercise, and these morphologic changes can be seen on echocardiograms. Sometimes, these morphologic changes are confused with the changes seen in patients with hypertrophic cardiomyopathy (HCM). A few important morphologic differences exist. In athletic heart syndrome, the hypertrophy is usually symmetrical, as opposed to the asymmetrical hypertrophy in HCM. Also, the left ventricular size is generally normal or increased, and the left atrial size is normal, as opposed to a small left ventricular cavity with a larger left atrial cavity size (usually >4.5 cm) in HCM. Despite these differences, sometimes making a distinction between 2 conditions is a challenge.

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Dehydration vis-à-vis exercise:

Dehydration refers both to hypohydration (dehydration induced prior to exercise) and to exercise-induced dehydration (dehydration that develops during exercise). The latter reduces aerobic endurance performance and results in increased body temperature, heart rate, perceived exertion, and possibly increased reliance on carbohydrate as a fuel source. Although the negative effects of exercise-induced dehydration on exercise performance were clearly demonstrated in the 1940s, athletes continued to believe for years thereafter that fluid intake was not beneficial. More recently, negative effects on performance have been demonstrated with modest (<2%) dehydration, and these effects are exacerbated when the exercise is performed in a hot environment. The effects of hypohydration may vary, depending on whether it is induced through diuretics or sauna exposure, which substantially reduce plasma volume, or prior exercise, which has much less impact on plasma volume. Hypohydration reduces aerobic endurance, but its effects on muscle strength and endurance are not consistent and require further study. Intense prolonged exercise produces metabolic waste heat, and this is removed by sweat-based thermoregulation. A male marathon runner loses each hour around 0.83 L in cool weather and 1.2 L in warm (losses in females are about 68 to 73% lower).  People doing heavy exercise may lose two and half times as much fluid in sweat as urine. This can have profound physiological effects. Cycling for 2 hours in the heat (35 °C) with minimal fluid intake causes body mass decline by 3 to 5%, blood volume likewise by 3 to 6%, body temperature to rise constantly, and in comparison with proper fluid intake, higher heart rates, lower stroke volumes and cardiac outputs, reduced skin blood flow, and higher systemic vascular resistance. These effects are largely eliminated by replacing 50 to 80% of the fluid lost in sweat.

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Hyperthermia vis-à-vis exercise:

Humans use sweat thermoregulation for body heat removal, particularly to remove the heat produced during exercise. Moderate dehydration as a consequence of exercise and heat is reported to impair cognition. These impairments can start after body mass lost that is greater than 1%. Cognitive impairment, particularly due to heat and exercise is likely to be due to loss of integrity to the blood brain barrier. Hyperthermia also can lower cerebral blood flow, and raise brain temperature.

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Other physiological changes in exercise:

•Plasma catecholamine concentrations increase 10-fold in whole body exercise.

•Ammonia is produced by exercised skeletal muscles from ADP (the precursor of ATP) by purine nucleotide deamination and amino acid catabolism of myofibrils.

•interleukin-6 (IL-6) increases in blood circulation due to its release from working skeletal muscles. This release is reduced if glucose is taken, suggesting it is related to energy depletion stresses.

•Sodium absorption is affected by the release of interleukin-6 as this can cause the secretion of arginine vasopressin which, in turn, can lead to exercise-associated dangerously low sodium levels (hyponatremia). This loss of sodium in blood plasma can result in swelling of the brain. This can be prevented by awareness of the risk of drinking excessive amounts of fluids during prolonged exercise.

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In a nutshell, exercise is accomplished by alteration in the body response to the physical stress (exercise physiology). These responses to exercise include an increase in the HR, BP, SV, cardiac output, ventilation, and VO2. The metabolism at the cellular level is also modulated to accommodate the demands of exercise. These changes occur temporarily during the exercise. Long-term changes also occur in the body metabolism and function.

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Hormones involved in regulating exercise are depicted in the table below:

 

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How hormones regulate fuels for exercise is depicted in the figure below:

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Fuel used for exercise:

The body uses different amounts of energy substrates (carbohydrates or fats) depending on the intensity of the exercise and the heart rate of the exerciser. Protein is a third energy substrate, but it contributes minimally and is therefore discounted in the percent contribution graphs reflecting different intensities of exercise. Carbohydrate and fat are the main substrates for the muscle used during aerobic exercise. Carbohydrates are stored in the body as muscle glycogen, liver glycogen and circulating as plasma glucose. Fat is stored as adipose tissue and as intramuscular triglyceride (IMTG). In addition, some fat is present in the circulation as plasma free fatty acids (FFA) and as triglycerides (TG) incorporated in lipoproteins. During aerobic exercise there is a mixture of fat and carbohydrate utilisation. However, the relative contribution of fat and carbohydrate utilisation to total substrate metabolism is dependent on exercise intensity, exercise duration, dietary and training status. The fuel provided by the body dictates an individual’s capacity to increase the intensity level of a given activity. In other words, the intensity level of an activity determines the order of fuel recruitment. Specifically, exercise physiology dictates that low intensity, long duration exercise provides a larger percentage of fat contribution in the calories burned because the body does not need to quickly and efficiently produce energy (i.e., adenosine triphosphate) to maintain the activity. On the other hand, high intensity activity utilizes a larger percentage of carbohydrates in the calories expended because its quick production of energy makes it the preferred energy substrate for high intensity exercise. High intensity activity also yields a higher total caloric expenditure.

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This table outlines the estimated distribution of energy consumption at different intensity levels for a healthy 20-year-old with a Max Heart Rate (MHR) of 200.

Intensity (%MHR) Heart Rate (bpm)  % Carbohydrate  % Fat
65-70 130-140 15 85
70-75 140-150 35 65
75-80 150-160 65 35
80-85 160-170 80 20
85-90 170-180 90 10
90-95 180-190 95 5
100 190-200 100 -

These estimates are valid only when glycogen reserves are able to cover the energy needs. If a person depletes glycogen reserves after a long workout (a phenomenon known as “hitting the wall”) or during a low carbohydrate diet, the body will shift into ketosis and use mostly fat and ketones for energy. Intermittent fasting can be used to train the body to shift easily into ketosis.

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Fuel usage (light exercise):

The best examples of light exercise are walking and light jogging. The muscles that are recruited during this type of exercise are those that contain a large amount of type I muscle cells, and, because these cells have a good blood supply, it is easy for fuels and oxygen to travel to the muscle. ATP consumption makes ADP available for new ATP synthesis. The presence of ADP (and the resulting synthesis of ATP) simulates the movement of hydrogen (H+) into the mitochondria; this, in turn, reduces the proton gradient and thus stimulates electron transport. The hydrogen on the reduced form of nicotinamide adenine dinucleotide (NADH) is used up, nicotinamide adenine dinucleotide (NAD) becomes available, and fatty acids and glucose are oxidized. Incidentally, the calcium released during contraction stimulates the enzymes in the Krebs cycle and stimulates the movement of the glucose transporter 4 (GLUT-4) from inside of the muscle cell to the cell membrane. Both these exercise-induced responses augment the elevation in fuel oxidation caused by the increase in ATP consumption.

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Fuel usage (moderate exercise):

An increase in the pace of running simply results in an increased rate of fuel consumption, an increased fatty acid release, and, therefore, an increase in the rate of muscle fatty acid oxidation. However, if the intensity of the exercise increases even further, a stage is reached in which the rate of fatty acid oxidation becomes limited. The reasons why the rate of fatty acid oxidation reaches a maximum are not clear, but it is possible that the enzymes in the beta-oxidation pathway are saturated (i.e., they reach a stage in which their maximal velocity [Vmax] is less than the rate of acetyl-coenzyme A [acetyl-CoA] consumption in the Krebs cycle). Alternatively, it may be that the availability of carnitine (the chemical required to transport the fatty acids into the mitochondria) becomes limited. Whatever the reason, the consequence is that as the pace rises, the demand for acetyl-CoA cannot be met by fatty acid oxidation alone. The accumulation of acetyl-CoA that was so effective at inhibiting the oxidation of glucose is no longer present, so pyruvate dehydrogenase starts working again and pyruvate is converted into acetyl-CoA. In other words, more of the glucose that enters the muscle cell is oxidized fully to carbon dioxide. Therefore, the energy used during moderate exercise is derived from a mixture of fatty acid and glucose oxidation.

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Fuel usage (strenuous exercise):

As the intensity of the exercise increases even further (i.e., running at the pace of middle-distance races), the rate at which the muscles can extract glucose from the blood becomes limited. In other words, the rate of glucose transport reaches Vmax, either because the blood cannot supply the glucose fast enough or the number of GLUT-4s becomes limited. ATP generation cannot be serviced completely by exogenous fuels, and ATP levels decrease. Not only does this stimulate phosphofructokinase, it also stimulates glycogen phosphorylase. This means that glycogen stored within the muscle cells is broken down to provide glucose. Therefore, the fuel mix during strenuous exercise is composed of contributions from blood-borne glucose and fatty acids and from endogenously stored glycogen.

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Fuel usage in individuals who are unfit:

Being fit (biochemically speaking) means that the individual has a well-developed cardiovascular system that can efficiently supply nutrients and oxygen to the muscles. Fit people have muscle cells that are well perfused with capillaries (i.e., they have a good muscle blood supply). Their muscle cells also have a large number of mitochondria, and those mitochondria have a high activity of Krebs cycle enzymes, electron transport carriers, and oxidation enzymes. Individuals who are unfit must endure the consequences of a poorer blood supply, fewer mitochondria, less electron transport units, a lower activity of the Krebs cycle, and poorer activity of beta-oxidation enzymes. To generate ATP in the mitochondria, a steady supply of fuel and oxygen and decent activity of the oxidizing enzymes and carriers are needed. If any of these components are lacking, the rate at which ATP can be produced by mitochondria is compromised. Under these circumstances, the production of ATP by aerobic means is not sufficient to provide the muscles with sufficient ATP to sustain contractions. The result is anaerobic ATP generation using glycolysis. Increasing the flux through glycolysis but not increasing the oxidative consumption of the resulting pyruvate increases the production of lactate.

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Metabolic adaptation in trained individuals:

Endurance trained humans rely less on muscle glycogen and plasma glucose and more on fats as an energy source during exercise at any given absolute or even relative intensity as compared to untrained humans. These differences are due to physiologic, biochemical and hormonal adaptations to endurance training. It is evident that the metabolic adaptations to training are largely mediated by an increase in mitochondrial density and muscle capillary density. The increase in mitochondrial density is explained by an increase in both number and size of the mitochondria. This increase following endurance training leads to an increase of the mitochondrial enzymes responsible for the activation, mitochondrial transport, β-oxidation of fatty acids, and enzymes of the tricarboxylic (TCA)-cycle. The alterations in substrate utilisation with endurance training are likely explained by a lesser disturbance of energetic homeostasis. With a greater mitochondrial volume after training, smaller decreases in ATP, phosphocreatine (PCr) and smaller increases in ADP and inorganic phosphate (Pi) are required during exercise to balance the rate of ATP synthesis with the rate of ATP hydrolysis. The smaller increase in ADP, results in less of an increase in AMP formation by AMPK (=adenylate kinase) and, therefore, also less of an increase in IMP and NH4+ formation by AMP deaminase. These metabolic alterations, especially the smaller increases in Pi and AMP, play a major role in reducing glycogenolytic rate in muscle that has been adapted to endurance training. Although important, the augmention of muscle respiratory capacity is not the only mechanism by which training affects substrate metabolism during exercise. Neuro-endocrine responses, which are modified by endurance training, play a major role in regulating substrate mobilisation and utilisation. For example plasma norepinephrine, epinephrine, growth hormone, cortisol, and adrenocorticotropic hormone increase less during exercise at the same absolute exercise intensity in the trained state, compared to the untrained state. Reduced catecholamine levels after training may contribute to many of the previously described alterations in substrate metabolism during exercise. For example, the slower rate of muscle glycogenolysis during exercise after training may be due, in part, to lower catecholamine levels. Similarly, lower catecholamine levels, in conjunction with less of a decline in insulin secretion, seem likely to contribute to the reduced rates of hepatic glucose production during exercise after training. It is now quite clear that endurance training leads to decreased reliance on carbohydrate oxidation and an increased reliance on fat oxidation at any given exercise intensity. However, the relative contribution of the different fat sources used during exercise remains debated.

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Myth of fat burning exercise:

A recurring question has been whether you should run or walk in order to burn as much fat as possible. Put differently, what is better – high- or low-intensity exercise? The background for this question is that during low-intensity muscular work (30-40% of maximum oxygen uptake, a measure of physical fitness), the metabolism of fat comprises roughly half the total energy, while only 20-30% of the energy (or less) comes from fat during high-intensity physical activity like interval training. While 55% of the energy comes from fat at 40 % of maximum oxygen uptake, this is reduced to 20% at an intensity of 80%. This knowledge has led to recommendations that people desiring to burn as much fat as possible should do low-intensity exercise – a message amplified by the use of terms like “fat burning exercise.” However, claims like these are based on a misunderstanding. In reality, it is the total energy spent, as opposed to the percentage of energy from fat that should be the concern. Under high-intensity exercise, not only is the energy expenditure per unit of time greater, but totally, more fat is metabolized compared to low-intensity exercise, even if the percentage of energy from carbohydrate is greater. For instance, at 75% of maximum oxygen uptake, the energy from fat and carbohydrates can be, respectively, approximately 30 and 70%, while at 40% of maximum oxygen uptake (so-called “fat burning exercise”), they might be roughly 50-50. If in the first case the energy expenditure were 12 kcal/min, and in the second it were 6 kcal/min, in the course of an hour one would use 720 kcal and 360 kcal, respectively. Of these, respectively 216 kcal and 180 kcal would be from fat. This shows that during high-intensity exercise, not only is more energy spent, but more fat is also burned per unit of time. Similarly, you don’t lose more fat if you bike a given distance at a relaxed rate versus biking the same distance at a higher speed in a shorter amount of time.

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Myth of muscle converting into fat tissue:

Some people incorrectly believe that muscle tissue will turn into fat tissue once a person stops exercising. This is not literally true — fat tissue and muscle tissue are fundamentally different — but the common expression that “muscle will turn to fat” is truthful in the sense that catabolism of muscle fibers for energy can result in excess glucose being stored as fat. Moreover, the composition of a body part can change toward less muscle and more fat, so that a cross-section of the upper-arm for example, will have a greater area corresponding to fat and a smaller area corresponding to muscle. This is not muscle “turning into fat” however — it is simply a combination of muscle atrophy and increased fat storage in different tissues of the same body part. Another element of increased fatty deposits is that of diet, as most trainees will not significantly reduce their diet in order to compensate for the lack of exercise/activity.

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Myth of lactate and muscle fatigue:

Certainly, repeated, high intensity contractions lead to muscle fatigue. Glycogenolysis and glycolysis can lead to lactic acidosis and disturbances to muscle and plasma pH. Furthermore, contractions also precipitate a variety of other disturbances to cell homeostasis including perturbations to energy charge and ion balances.

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When you exercise, your body uses oxygen to break down glucose for energy. During intense exercise, there may not be enough oxygen available to complete the process, so a substance called lactate is made. Researchers once attributed fatigue to a build-up of lactic acid in muscles. However, this is no longer believed. Most athletes believe that lactate causes muscle fatigue by making the muscles too acidic to contract effectively. This is not true. While the muscles do become more acidic during exercise, lactate is not the cause. In any case, far from hastening fatigue, lactate accumulation in the muscles actually delays fatigue by mitigating the effects of a phenomenon known as depolarization. Each muscle contraction involves an action potential that activates voltage sensors, and so releases Ca2+ ions from the muscle fibre’s sarcoplasmic reticulum. The action potentials that cause this require also ion changes: Na influxes during the depolarization phase and K effluxes for the repolarization phase. Cl− ions also diffuse into the sarcoplasm to aid the repolarization phase. During intense muscle contraction, the ion pumps that maintain homeostasis of these ions are inactivated and this (with other ion related disruption) causes ionic disturbances. This causes cellular membrane depolarization.  During intense exercise, your muscles lose power in the same way a battery does: by becoming depolarized. The accumulation of lactate in muscle tissue during intense exercise partly counteracts the effect of depolarization. Lactate does not cause post-exercise muscle soreness. The simplest proof of this is the fact that very little lactate is produced during highly prolonged, low-intensity exercise, and yet it is this very type of exercise that leaves the muscles sorest in the following days. Post-exercise muscle soreness is actually caused by simple mechanical damage to muscle fibers, free radical damage, and inflammation. Without lactate, you would not get fitter in response to training to the same degree you do with it. Lactate production during intense exercise stimulates a phenomenon called mitochondrial biogenesis after exercise. The mitochondria are little factories inside the muscle cells where aerobic metabolism occurs—that is, where oxygen is used to break down fats and glucose to yield energy. An increase in the concentration of mitochondria inside muscle cells is one of the major adaptations to training that improve endurance performance. And lactate makes it happen. This is one of the reasons high-intensity interval training is such a potent performance booster. We are aware that lactate produced during exercise can be “recycled” into glucose and used as fuel by the muscles, heart, and brain. But few are aware that lactate is also metabolized aerobically in the mitochondria as a direct fuel for muscle contractions. In fact, it has been estimated that roughly 75 percent of the lactate produced inside the muscle cells is used in this way, and only 25 percent leaks out into the bloodstream, where it can be measured through blood lactate testing.  Some of the world’s best endurance athletes, such as Michael Phelps, appear to produce significantly less lactate during intense exercise than lesser athletes. This makes sense if you believe that lactate is a toxic waste product that causes fatigue and does not help exercise performance in any way. But it doesn’t make sense in the light of current knowledge about the effects of lactic acid. And it’s also very unlikely to be true. In all likelihood, the reason there is less lactate in the blood of Michael Phelps during intense exercise is not that their muscles produce less, but rather that they use more. If, in the average endurance athlete, 75 percent of lactate is burned in the mitochondria and only 25 percent escapes into the bloodstream, in come very special athletes, perhaps 85 percent of lactate is burned and only 15 percent escapes.

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Muscles, Oxygen and Intensity of Exercise:

If you are going to be exercising for more than a couple of minutes, your body needs to get oxygen to the muscles or the muscles will stop working. Just how much oxygen your muscles will use depends on two processes: getting blood to the muscles and extracting oxygen from the blood into the muscle tissue. Your working muscles can take oxygen out of the blood three times as well as your resting muscles. Your body has several ways to increase the flow of oxygen-rich blood to working muscle:

•increased local blood flow to the working muscle

•diversion of blood flow from nonessential organs to the working muscle

•increased flow of blood from the heart (cardiac output)

•increased rate and depth of breathing

•increased unloading of oxygen from hemoglobin in working muscle

These mechanisms can increase the blood flow to your working muscle by almost five times. That means that the amount of oxygen available to the working muscle can be increased by almost 15 times!

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Vigorous physical activity (such as exercise or hard labor) increases the body’s demand for oxygen. The first-line physiologic response to this demand is an increase in heart rate, breathing rate, and depth of breathing. Oxygen consumption (VO2) during exercise is best described by the Fick Equation: VO2 = Q X (a-v O2diff), which states that the amount of oxygen consumed is equal to cardiac output (Q) multiplied by the difference between arterial and venous oxygen concentrations. More simply put, oxygen consumption is dictated by the quantity of blood distributed by the heart as well as the working muscle’s ability to take up the oxygen within that blood; however, this is a bit of an oversimplification. Although cardiac output is thought to be the limiting factor of this relationship in healthy individuals, it is not the only determinant of VO2 max. That is, factors such as the ability of the lung to oxygenate the blood must also be considered. Various pathologies and anomalies cause conditions such as diffusion limitation, ventilation/perfusion mismatch, and pulmonary shunts that can limit oxygenation of the blood and therefore oxygen distribution. In addition, the oxygen carrying capacity of the blood is also an important determinant of the equation. Oxygen carrying capacity is often the target of exercise (ergogenic aids) aids used in endurance sports to increase the volume percentage of red blood cells (hematocrit), such as through blood doping or the use of erythropoietin (EPO). Furthermore, peripheral oxygen uptake is reliant on a rerouting of blood flow from relatively inactive viscera to the working skeletal muscles, and within the skeletal muscle, capillary to muscle fiber ratio influences oxygen extraction.

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VO2 max (maximum oxygen uptake):

The maximum rate of oxygen consumption during the aerobic catabolism of pyruvic acid/fatty acid is called maximal oxygen uptake. VO2 max (also maximal oxygen consumption, maximal oxygen uptake, peak oxygen uptake or maximal aerobic capacity) is the maximum rate of oxygen consumption as measured during incremental exercise, most typically on a motorized treadmill.  Maximal oxygen consumption reflects the aerobic physical fitness of the individual, and is an important determinant of their endurance capacity during prolonged, sub-maximal exercise. Maximal oxygen uptake (VO2 max) is widely accepted as the single best measure of cardiovascular fitness and maximal aerobic power. The name is derived from V – volume, O2 – oxygen, max – maximum. Maximal oxygen uptake is determined by sex (higher in males), age (highest at approximately age 20 y), and size (increases with body size). This rate in short-term studies is found to increase only 10% with the effect of training. However, that of a person who runs in marathons is 45% greater than that of an untrained person. This is believed to be partly genetically determined (e.g., stronger respiratory muscles, larger chest size in relation to body size) and partly due to long-term training. Highly trained athletes can have maximal oxygen uptakes that are twice that of average people, probably owing to a combination of genetics and training. As a result, highly trained athletes are capable of greater muscular activity without increasing their lactic acid production and have lower oxygen debts, which is why they do not become short of breath as readily as untrained individuals.

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The usual VO2 measurements are in L/min; however, if the size of the individual needs to be accounted for, the measurements may be in mL/kg/min. One metabolic unit (MET) equals the VO2 at rest. The estimate of the value of one MET is 3.5 mL of oxygen per kg/min. Conversion of VO2 measurements may be obtained by dividing the value of the VO2 in mL of oxygen per kg/min by the value of one MET or 3.5. For example, a VO2 measurement of 35 mL of oxygen per kg/min is equivalent to an output of 10 METs.  Absolute values of VO2 max are typically 40-60% higher in men than in women. The average untrained healthy male will have a VO2 max of approximately 35–40 mL/kg/min. The average untrained healthy female will score a VO2 max of approximately 27–31 mL/kg/min. In sports where endurance is an important component in performance, such as cycling, rowing, cross-country skiing, swimming and running, world-class athletes typically have high VO2 max. Elite male runners can consume up to 85 mL/kg/min, and female elite runners can consume about 77 mL/kg/min.  In other words, while doing maximum effort exercise, an average person uses oxygen 10 times that of rest and highly trained athlete doing the same exercise uses oxygen half of that of average person as intensity of the same exercise will be lower in highly trained athlete. In other words, maximum effort exercise performed by highly trained athlete is of double intensity than maximum effort exercise performed by average man.

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Training enhances the ability of the body, in particular the muscle cells, to better handle oxygen. Muscle must be able to use oxygen efficiently to keep anaerobic metabolism at a given level of effort to a minimum. Cardiac output is a major determinant of oxygen uptake. VO2max declines with age as the maximum HR declines. This is one of the major factors causing the approximately 7% decline with each decade of life after age 30 years. Muscle training and use of oxygen at the end organ, muscle, is the second factor that affects oxygen uptake. The arterial-venous oxygen difference comes about as a combination of arterial oxygen content, shunting of blood to muscles, and the muscle extraction of oxygen. Training results in a more efficient heart and an increase in the maximum stroke volume (SV). An increase in VO2 results in an ease in the stress of a given workload. When maximum SV is increased, the heart can work more efficiently at a given pulse rate. This lessens the necessity of an increased pulse at a given workload. Resting pulse is lower, as is the pulse at any given workload.

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Components of exercise:

An exercise prescription generally includes the following specific recommendations:

• Type of exercise or activity (e.g., walking, swimming, cycling)

• Specific workloads (e.g., watts, walking speed)

• Duration and frequency of the activity or exercise session

• Intensity of exercise

• Precautions regarding certain orthopedic (or other) concerns or related comments

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Aerobic activity causes a person’s heart to beat faster than usual.

Aerobic physical activity has three components:

•Intensity, or how hard a person works to do the activity. The intensities most often examined are moderate intensity (equivalent in effort to brisk walking) and vigorous intensity (equivalent in effort to running or jogging);

•Frequency, or how often a person does aerobic activity; and

•Duration, or how long a person does an activity in any one session.

Although these components make up a physical activity profile, research has shown that the total amount of physical activity (minutes of moderate–intensity physical activity, for example) is more important for achieving health benefits than is any one component (frequency, intensity, or duration).

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Muscle-Strengthening Activity:

This kind of activity, which includes resistance training and lifting weights, causes the body’s muscles to work or hold against an applied force or weight. These activities often involve relatively heavy objects, such as weights, which are lifted multiple times to train various muscle groups. Muscle-strengthening activity can also be done by using elastic bands or body weight for resistance (climbing a tree or doing push-ups, for example).

Muscle-strengthening activity also has three components:

•Intensity, or how much weight or force is used relative to how much a person is able to lift;

•Frequency, or how often a person does muscle strengthening activity; and

•Repetitions, or how many times a person lifts a weight (analogous to duration for aerobic activity). The effects of muscle-strengthening activity are limited to the muscles doing the work. It’s important to work all the major muscle groups of the body: the legs, hips, back, abdomen, chest, shoulders, and arms.

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Exercise intensity:

Intensity refers to the rate at which the activity is being performed or the magnitude of the effort required to perform an activity or exercise. Intensity is the rate of energy expenditure of exercise. It can be thought of “How hard a person works to do the activity”. The intensity of different forms of physical activity varies between people. The intensity of physical activity depends on an individual’s previous exercise experience and their relative level of fitness. Exercise intensity refers to how much energy is expended when exercising. Perceived intensity varies with each person. It has been found that intensity has an effect on what fuel the body uses and what kind of adaptations the body makes after exercise. Intensity is the amount of physical power (expressed as a percentage of the maximal oxygen consumption) that the body uses when performing an activity. For example, exercise intensity defines how hard the body has to work to walk a mile in 20 minutes. Heart Rate is typically used as a measure of exercise intensity.  Heart rate can be an indicator of the challenge to the cardiovascular system that the exercise represents. The most precise measure of intensity is oxygen consumption (VO2). VO2 represents the overall metabolic challenge that an exercise imposes. There is a direct linear relationship between intensity of aerobic exercise and VO2. Our maximum intensity is a reflection of our maximal oxygen consumption (VO2 max). Such a measurement represents a cardiovascular fitness level. VO2 is measured in METs (mL/kg/min). One MET, which is equal to 3.5 ml/kg per minute, is considered to be the average resting energy expenditure of a typical human being. Intensity of exercise can be expressed as multiples of resting energy expenditure. An intensity of exercise equivalent to 6 METs means that the energy expenditure of the exercise is six times the resting energy expenditure. Some studies measure exercise intensity by having subjects perform exercise trials to determine peak power output, which may be measured in watts, heart rate, or (on a cycle) average cadence (cycling). This approach attempts to gauge overall workload.

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The Metabolic Equivalent of Task (MET):

MET is the ratio of the work metabolic rate to the resting metabolic rate (RMR). One MET is defined as 1 kcal/kg/hour and is roughly equivalent to the energy cost of sitting quietly. A MET also is defined as oxygen uptake in ml/kg/min with one MET equal to the oxygen cost of sitting quietly, equivalent to 3.5 ml/kg/min. 1 MET is also defined as 58.2 W/m2 (18.4 Btu/h·ft2), which is equal to the rate of energy produced per unit surface area of an average person seated at rest.  MET values of activities range from 0.9 (sleeping) to 23 (running at 22.5 km/h or a 4:17 mile pace). Although the RMR of any person may deviate from the reference value, MET can be thought of as an index of the intensity of activities: for example, an activity with a MET value of 2, such as walking at a slow pace (e.g., 3 km/h) would require twice the energy that an average person consumes at rest (e.g., sitting quietly).  MET is used as a means of expressing the intensity and energy expenditure of activities in a way comparable among persons of different weight. Actual energy expenditure (e.g., in calories or joules) during an activity depends on the person’s body mass; therefore, the energy cost of the same activity will be different for persons of different weight. However, since the RMR is also dependent on body mass in a similar way, it is assumed that the ratio of this energy cost to the RMR of each person will remain more or less stable for the specific activity and thus independent of each person’s weight. The 1 MET reference value of 1 kcal·kg−1·h−1 is used by convention and refers to a typical metabolism at rest of an “average” individual. It must not be confused or misused as an approximation of Basal Metabolic Rate (BMR), which is the minimum metabolic rate obtained under specified conditions. This is illustrated by the fact that sleeping has a MET of 0.9, while an individual’s normal sleeping metabolism may be greater than the BMR.

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MET-minutes:

For example, 1 MET is the rate of energy expenditure while at rest. A 4 MET activity expends 4 times the energy used by the body at rest. If a person does a 4 MET activity for 30 minutes, he or she has done 4 x 30 = 120 MET-minutes (or 2.0 MET-hours) of physical activity. A person could also achieve 120 MET-minutes by doing an 8 MET activity for 15 minutes.

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MET-Minutes and Health Benefits:

A key finding of various studies is that the health benefits of physical activity depend mainly on total weekly energy expenditure due to physical activity. In scientific terms, this range is 500 to 1,000 MET-minutes per week. A range is necessary because the amount of physical activity necessary to produce health benefits cannot yet be identified with a high degree of precision; this amount varies somewhat by the health benefit. For example, activity of 500 MET-minutes a week results in a substantial reduction in the risk of premature death, but activity of more than 500 MET-minutes a week is necessary to achieve a substantial reduction in the risk of breast cancer. There is a dose-response relationship between physical activity and health benefits. A range of 500 to 1,000 MET-minutes of activity per week provides substantial benefit, and amounts of activity above this range have even more benefit. Amounts of activity below this range also have some benefit. The dose-response relationship continues even within the range of 500 to 1,000 MET-minutes, in that the health benefits of 1,000 MET-minutes per week are greater than those of 500 MET-minutes per week.

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Two Methods of assessing Aerobic Intensity:

The intensity of aerobic physical activity can be defined in absolute or relative terms.

Absolute Intensity:

Absolute moderate-intensity or vigorous-intensity physical activity is necessary for substantial health benefits, and absolute aerobic intensity is defined in terms of METs as follows:

•Light-intensity activities are defined as 1.1 MET to 2.9 METs.

•Moderate-intensity activities are defined as 3.0 to 5.9 METs. Walking at 3.0 miles per hour requires 3.3 METs of energy expenditure and is therefore considered a moderate-intensity activity.

•Vigorous-intensity activities are defined as 6.0 METs or more. Running at 10 minutes per mile (6.0 mph) is a 10 MET activity and is therefore classified as vigorous intensity.

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Figure above shows the movement continuum: illustrating different physical activity intensities. METs= metabolic equivalent tasks. SB= sedentary behavior.

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Relative Intensity:

Relative intensity refers to the percent of aerobic power utilized during exercise and is expressed as percent of maximal heart rate or percent of VO2max. Moderate-intensity activities are those performed at a relative intensity of 40% to 60% of VO2max (or absolute intensity of 4 to 6 METs). Vigorous-intensity activities are those performed at a relative intensity of 60% to 80% of VO2max (or absolute intensity of 6 to 8 METs). For example, brisk walking at 3 miles/hr has an absolute intensity of 4 METs. In relative terms, this intensity is considered light for a 20-year-old healthy person but represents a vigorous intensity for an 80-year-old person. Another example, two individuals with different measures of VO2 max, running at 7 mph are running at the same absolute intensity (miles/hour) but a different relative intensity (% of VO2 max expended). The individual with the higher VO2 max is running at a lower intensity at this pace than the individual with the lower VO2 max is.

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Physical activity MET
Light intensity activities: < 3
sleeping 0.9
watching television 1.0
writing, desk work, typing 1.5
walking, 1.7 mph (2.7 km/h), level ground, strolling, very slow 2.3
walking, 2.5 mph (4 km/h) 2.9
Moderate intensity activities: 3 to 6
bicycling, stationary, 50 watts, very light effort 3.0
walking 3.0 mph (4.8 km/h) 3.3
calisthenics, home exercise, light or moderate effort, general 3.5
walking 3.4 mph (5.5 km/h) 3.6
bicycling, <10 mph (16 km/h), leisure, to work or for pleasure 4.0
bicycling, stationary, 100 watts, light effort 5.5
sexual activity 5.8
Vigorous intensity activities: > 6
jogging, general 7.0
calisthenics (e.g. pushups, situps, pullups, jumping jacks), heavy, vigorous effort 8.0
running jogging, in place 8.0
rope jumping 10.0

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150 minutes (2 hours and 30 minutes) of moderate-intensity activity per week could be regarded as (roughly) equivalent to 500 MET-minutes per week. In fact, 3.3 METs for 150 minutes per week is equal to 500 MET-minutes per week. By recommending that adults do at least 150 minutes of moderate-intensity activity per week, adults will achieve 500 to 1,000 MET-minutes per week if the intensity is 3.3 METs or greater. As noted earlier, walking at 3.0 miles per hour is a 3.3 MET activity. Hence, it is appropriate to communicate to the public that a “brisk walk” is walking at 3.0 miles per hour or faster.  By recommending at least 75 minutes (1 hour and 15 minutes) per week of vigorous-intensity activity, adults who choose to do vigorous-intensity activity will also generally achieve 500 to 1,000 MET-minutes per week. The lower limit of vigorous intensity activity (6.0 METs) is twice the lower limit of moderate-intensity activity (3.0 METs). So, 75 minutes of vigorous-intensity activity per week is roughly equivalent to 150 minutes of moderate-intensity activity per week. As the MET range for vigorous-intensity activity has no upper limit, highly fit people can even exceed 1,000 MET-minutes in 75 minutes by doing activities requiring 13.4 MET or more. It is not of concern that the vigorous-intensity guideline “misleads” people with a high degree of fitness into doing more activity than is really required to meet the guidelines. Highly fit people have already decided to do large amounts of physical activity, as this is the only way to achieve this degree of fitness. Because 150 minutes of moderate-intensity activity and 75 minutes of vigorous-intensity activity are the minimum amounts, the rule of thumb becomes that 1 minute of vigorous-intensity activity counts the same as 2 minutes of moderate-intensity activity.

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Energy expenditure calculations:

Per-minute calculation: To calculate kilocalories per minute (kcal/min), multiply the METs times 3.5 times body weight in kilograms (kg) and divide by 200 (i.e., kcal/min = [MET X 3.5 X kg body weight]/200). For example, the energy (caloric) expenditure of a 70-kg individual at a prescribed 6-MET capacity with a weekly goal of 1000 kcl per week is calculated as (6 X 3.5 X 70 kg)/200, which equals 7.35 kcal/min (30.87 kJ/min). To convert kilocalories to kilojoules, note that 1 kcal = 4.2 kJ.

Per-week calculation: This determines the exercise duration per week. Using the numbers from the example above, divide 1000 kcal (4200 kJ) by 7.35 kcal/min (30.87 kJ/min), which equals 136 min/week or approximately 20-30 minutes, 6 d/wk.

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Without using any calculator, you can classify intensity of exercise as:

•Light exercise

The exerciser is able to talk while exercising. Going for a walk is an example of light exercise.

•Moderate exercise

The exerciser feels slightly out of breath during the session. Moderate-intensity aerobic activity means you’re working hard enough to raise your heart rate and break a sweat. One way to tell if you’re working at a moderate intensity is if you can still talk but you can’t sing the words to a song. Examples could be walking briskly, cycling moderately, or walking up a hill.

•Vigorous exercise

The exerciser is panting during the activity. If your heart rate increases a lot and you are breathing so hard that it is difficult to carry on a conversation, you are probably doing vigorous-intensity activity. The exerciser feels his/her body is being pushed much nearer its limit, compared to the other two intensities. This could include running, cycling fast, and heavy weight training.

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Heart rate as surrogate measure of energy expenditure and exercise intensity:

During moderate physical activity, there is a linear relationship between heart rate and oxygen consumption. This heart rate oxygen consumption relationship is subject to both intra- and inter-individual variability. Heart rate may be partially dissociated from energy expenditure by factors such as emotion, posture and environmental conditions. Heart rate monitoring, for estimating free-living energy expenditure, has been extensively validated using indirect calorimetry, doubly labelled water and wholeroom respirometry, and reported differences between measures range from -20% to +25%. In large groups of people, heart rate monitoring provides one of the most efficient and economical means of estimating energy expenditure. In addition, heart rate monitoring provides useful insights into the type of activity being undertaken over the measurement period. Other assessment methods, such as doubly labelled water, can only convey the total amount of physical activity measured, whereas heart rate monitoring provides physiological information about the type of activities being performed and describes the nature of day-to-day variability in energy expenditure. While whole-room respirometry and indirect calorimetry provide physiological information about the nature of the activity being performed, these tools are not only costly to maintain, but often take the participant out of his or her natural environment for the duration of the measurement period.

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Heart Rate Goal:

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

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There are different types of heart rates.

1. Resting heart rate. The average heart rate for a person at rest is 60 – 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night’s sleep before you get out of bed.

2. Maximum heart rate. To determine your own maximum heart rate per minute, subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 – 45 = 175.

3. Target heart rate. Your target rate is 50 – 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called “diving reflex,” which causes the heart to slow down automatically when the body is immersed in water.

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Target Heart Rates for a One-minute Pulse Count
Age Low High
(50% max.) (75% max.)
20 100 150
30 95 142
40 90 135
50 85 127
60 80 120

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Intensity guide for aerobic exercise using heart rate:

When target heart rate is 60 to 80 % of maximum heart rate, it is moderate intensity exercise.

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In a nutshell, I classify and summarize exercise in the following table:

Elements Light exercise Moderate exercise (cardio) Vigorous (intense) exercise
Oxygen used or not Aerobic Aerobic Anaerobic plus aerobic
Fuel used Fat and carbohydrate Carbohydrate and fat Predominantly carbohydrate
MET 1.1 to 2.9 3 to 5.9 6 to 10 and even more
Oxygen consumption VO2 Less than 40 % of VO2 max 40 to 60 % of VO2 max 60 to 85 % of VO2 max
Target heart rate < 60 % of maximum heart rate 60 to 80 % of maximum heart rate 80 to 90 % of maximum heart rate aerobic glycolysis and > 90 % uses anaerobic glycolysis
Duration At least >  10 minutes e.g. strolling At least > 10 minutes e.g. brisk walking < 2 minutes e.g. weight lifting, > 2 minutes e.g. running
How exerciser react The exerciser is able to talk fluently while exercising You feel slightly out of breath, sweating but can still talk you are breathing so hard that it is difficult to carry on a conversation
Health benefits Little benefits Definite cardiovascular benefits with 150 minutes of exercise per week Building muscles and strengthening bones in short duration and cardiovascular benefit with 75 minutes of exercise per week

Maximum effort exercise is when exerciser makes so much efforts that he/she utilizes full VO2 max achieving maximum heart rate. Over-exercise is when person exercises for more than 2 hours continuously with the sole exception of highly trained athlete e.g. highly trained marathon runner

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Exercise Capacity:

Exercise capacity is the maximum amount of physical exertion that a patient can sustain. Exercise capacity is best defined in terms of maximal effort tolerance. An accurate assessment of exercise capacity requires that maximal exertion is sufficiently prolonged to have a stable (or steady state) effect on the circulation and that the pattern of patient response is consistent when exertion is repeated. The function of several body systems, particularly the circulation and respiratory systems, is adequately tested only during exercise. Each system has reserve capacity far in excess of that needed to sustain normal, asymptomatic body functioning at rest and during modest activity. Many disease processes affecting the circulation or respiration cause progressive loss of physiologic function. Such diseases are likely to manifest themselves initially by a reduction in cardiac or pulmonary reserve. Since these reserve capacities are tested only during exercise, the early (and potentially remediable) stages of diseases of this sort may produce symptoms only with strenuous effort. By assessing the maximum capability of patients to perform exercise, the examining physician evaluates, at least in qualitative terms, the reserve capacity of each of the organ systems contributing to the exercise response. Impairment of exercise capacity should alert the physician to a potential need for more specific and precise studies of organ function. Exercise performance reflects a coordinated response of cardiovascular, pulmonary, and neural function along with the action of exercising muscles. Exercise induces graded increases in heart rate, arterial pressure, cardiac output, myocardial contractility, and rate and depth of respiration. Rapid, reversible shifts also occur in the distribution of blood flow and in blood composition. These changes are orchestrated by the central nervous system, which is responding to direct cortical input and to neural and humoral feedback from exercising muscles. Neural control of cardiovascular function is exerted, in part, through characteristic increases in sympathetic stimulation and reciprocal decreases in para-sympathetic stimulation. During steady effort, cardiovascular and pulmonary parameters begin to stabilize (after 1 to 2 minutes of rapid change) at levels appropriate for a specific intensity of exercise in a particular patient. These steady-state levels can be used to characterize patient performance.

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Functional capacity:

Functional capacity is defined as the ability of a cell, organ, system, or body to maintain homeostasis within their narrow limits of survival in response to a specified stress. If an external stress disrupts homeostasis beyond an organism’s functional capacity, life may not be sustained. Diminished ability to adapt to stressors increases the likelihood of death. Functional capacity is pliable; declining rapidly with extreme physical inactivity or more slowly with aging, while preventing inactivity can increase functional capacity (considered in specific detail in the aging section). Importantly, a direct relationship between functional capacity and survival is a cornerstone of general medicine theory. A major predictor of functional capacity is maximal aerobic capacity (VO2max), which while directly testing cardiovascular fitness and integrity also represents a combination of other physiologic components. For instance, VO2max also depends on pulmonary and muscle function, health status of other organ systems, nutritional status, medications, orthopedic limitations, and others. An aerobic functional capacity in patients under 4-metabolic equivalents (METs), a typical demand during normal daily activities, increases postoperative (time from admission to discharge from surgery) cardiac and long-term risks. In another study, patients were grouped by MET capacity in relationship to complication prevalence after they underwent angiographically verified coronary artery disease and subsequent open abdominal nonvascular surgery. Those from the group < 4 METs had cardiologic complications in 64% of cases, the 4–7 METs group had 29%, and the 7–10 METs group had 8%. These remarkable findings can be extrapolated to other stresses where the probability of complications, and even survival, is dependent upon the functional capacity needed to maintain homeostasis.

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Biological effects of exercise:

There are number of biological effects that occur, from head to toe, when you exercise. This includes changes in your:

•Muscles, which use glucose and fatty acid to generate ATP for contraction and movement. To create more ATP, your body needs extra oxygen, so breathing increases and your heart starts pumping more blood to your muscles. Without sufficient oxygen, lactic acid will form instead. Tiny tears in your muscles make them grow bigger and stronger as they heal.

•Lungs. As your muscles call for more oxygen (as much as 15 times more oxygen than when you’re at rest), your breathing rate increases. Once the muscles surrounding your lungs cannot move any faster, you’ve reached what’s called your VO2 max—your maximum capacity of oxygen use. The higher your VO2 max, the fitter you are.

•Heart. As mentioned, your heart rate increases with physical activity to supply more oxygenated blood to your muscles. The fitter you are, the more efficiently your heart can do this, allowing you to work out longer and harder. As a positive side effect, this increased efficiency will also reduce your resting heart rate. Your blood pressure will also decrease as a result of new blood vessels forming.

•Brain. The increased blood flow also benefits your brain, allowing it to almost immediately function better. As a result, you tend to feel more focused after a workout. Furthermore, exercising regularly will promote the growth of new brain cells. In your hippocampus, these new brain cells help boost memory and learning. When you work out regularly, your brain gets used to this frequent surge of blood and adapts by turning certain genes on or off. Many of these changes boost brain cell function and protect from diseases such as Alzheimer’s, Parkinson’s or even stroke, and ward off age-related decline. A number of neurotransmitters are also triggered, such as endorphins, serotonin, dopamine, glutamate, and GABA. Some of these are well-known for their role in mood control. Exercise, in fact, is one of the most effective prevention and treatment strategies for depression.

•Joints and bones, as exercise can place as much as five or six times more than your body weight on them. Peak bone mass is achieved in adulthood and then begins a slow decline, but exercise can help you to maintain healthy bone mass as you get older. Weight-bearing exercise is actually one of the most effective remedies against osteoporosis, as your bones are very porous and soft, and as you get older your bones can easily become less dense and hence, more brittle — especially if you are inactive.

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Routine physical activity is also associated with improved psychological well-being (e.g., through reduced stress, anxiety and depression. Psychological well-being is particularly important for the prevention and management of cardiovascular disease, but it also has important implications for the prevention and management of other chronic diseases such as diabetes, osteoporosis, hypertension, obesity, cancer and depression.

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While evidence of the physical and mental benefits of exercise abounds, there exists no single, coherent theory that adequately explains why—despite many proposed explanations. One biological explanation asserts that exercise increases body temperature, adrenal and steroid activity, as well as the release of certain neurotransmitters such as endorphins. Another approach is psychosocial in origin and posits that exercise acts as a type of distraction, biofeedback, meditation, or psychological buffer and can result in an increased sense of self-efficacy, control, and mastery. Furthermore, some researchers have suggested that many of the derived psychological benefits may be due to expectancy effects; that is, “people may demonstrate improvement in psychological functioning simply because they are expecting self-enhancement”.

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Changes in endothelial function may be a particularly important adaptation to routine physical activity. Endothelial dysfunction has been observed with aging, smoking and multiple chronic disease states, including coronary artery disease, congestive heart failure, stroke, type 2 diabetes, hypertension, hypercholesterolemia and obesity.  Regular aerobic activity has been found to improve vascular function in adults independent of changes in other risk factors and has been said to result in a shear-stress–mediated improvement in endothelial function, which confers a health benefit to a number of disease states.

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Although most research into the mechanisms of how physical activity and fitness improve health outcomes has dealt with the relation between cardiovascular disease and physical activity, researchers have also evaluated the primary mechanisms responsible for decreases in the risk and severity of individual disease states. In fact, despite the adaptations that are of global benefit for multiple disease states, physical activity also results in specific adaptations that affect individual disease states. For instance, in type 2 diabetes, adaptations that affect glucose homeostasis are of great importance. As reviewed by Ivy, a series of changes (independent of changes in body mass) occur as a result of regular physical activity, including increased glycogen synthase and hexokinase activity, increased GLUT-4 protein and mRNA expression, and improved muscle capillary density (resulting in improved glucose delivery to the muscle). A series of mechanisms may explain the 46% reduction in cancer rates observed with regular physical activity, including reductions in fat stores, increased energy expenditure offsetting a high-fat diet, activity-related changes in sex hormone levels, immune function, insulin and insulin-like growth factors, free-radical generation, and direct effects on the tumour.

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Muscle as a secretory organ: Myokine research:

Skeletal muscle is the largest organ in the body. Skeletal muscles are primarily characterized by their mechanical activity required for posture, movement, and breathing, which depends on muscle fiber contractions. However, skeletal muscle is not just a component in our locomotor system. Recent evidence has identified skeletal muscle as a secretory organ. New research on the endocrine functions of contracting muscles has shown that both aerobic and anaerobic exercise promote the secretion of myokines, with attendant benefits including growth of new tissue, tissue repair, and various anti-inflammatory functions, which in turn reduce the risk of developing various inflammatory diseases. Myokine secretion in turn is dependent on the amount of muscle contracted, and the duration and intensity of contraction. As such, both types of exercise produce endocrine benefits. It is suggested that cytokines and other peptides that are produced, expressed, and released by muscle fibers and exert either autocrine, paracrine, or endocrine effects should be classified as “myokines.” The muscle secretome consists of several hundred secreted peptides. This finding provides a conceptual basis and a whole new paradigm for understanding how muscles communicate with other organs such as adipose tissue, liver, pancreas, bones, and brain. In addition, several myokines exert their effects within the muscle itself. Many proteins produced by skeletal muscle are dependent upon contraction. Therefore, it is likely that myokines may contribute in the mediation of the health benefits of exercise. In a 2012 article regarding myokine research, Pedersen and Febbraio concluded that “physical inactivity and muscle disuse lead to loss of muscle mass and accumulation of visceral adipose tissue and consequently to the activation of a network of inflammatory pathways, which promote development of insulin resistance, atherosclerosis, neurodegeneration and tumour growth and, thereby, promote the development of a cluster of chronic diseases. By contrast, the finding that muscles produce and release myokines provides a molecular basis for understanding how physical activity could protect against premature mortality…. Physical inactivity or muscle disuse potentially leads to an altered or impaired myokine response and/or resistance to the effects of myokines, which explains why lack of physical activity increases the risk of a whole network of diseases, including cardiovascular diseases, T2DM (Type 2 Diabetes Mellitus), cancer and osteoporosis.

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Physical activity and the endocannabinoid system: an overview: 2014:

Recognized as a “disease modifier”, physical activity (PA) is increasingly viewed as a more holistic, cost-saving method for prevention, treatment and management of human disease conditions. The traditional view that PA engages the monoaminergic and endorphinergic systems has been challenged by the discovery of the endocannabinoid system (ECS), composed of endogenous lipids, their target receptors, and metabolic enzymes. Indeed, direct and indirect evidence suggests that the ECS might mediate some of the PA-triggered effects throughout the body. Moreover, it is now emerging that PA itself is able to modulate ECS in different ways. ECS must be tightly regulated during PA, in order to maintain its beneficial effects on cognition, mood, and nociception, while avoiding impaired energy metabolism, oxidative stress, and inflammatory processes.

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Exercise and antioxidants:

Antioxidants prevent health-promoting effects of physical exercise in humans: 2009 study:

Exercise, as well as weight loss, has been linked to activation of mitochondrial metabolism, and reduced mitochondrial metabolism has been functionally connected with type 2 diabetes. Mitochondria, however, are also the main source of reactive oxygen species (ROS), which are inevitable by-products of oxidative glucose metabolism. Muscle is also known to generate free radicals, especially during contraction and physical exercise. It has been suggested that ROS may mediate some health-promoting effects, at least in nonprimate model systems.

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Mitohormesis links physical exercise and subsequent formation of reactive oxygen species to insulin sensitivity and antioxidant defense. Physical exercise exerts ameliorating effects on insulin resistance by increasing mitochondrial formation of reactive oxygen species in skeletal muscle to induce expression of PGC1α, PGC1β, and PPARγ as inducers of insulin sensitivity, as well as superoxide dismutases 1 and 2 and glutathione peroxidase 1, key enzymes of ROS defence. Notably, by blocking exercise-dependent formation of reactive oxygen species due to ingestion of antioxidant supplements, health promoting effects of physical exercise are abolished, and physical exercise fails to promote insulin sensitivity and antioxidant defense in the presence of vitamin C and vitamin E.

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Antioxidants are widely used as supplements but whether they affect the health-promoting effects of exercise is unknown. Authors evaluated the effects of a combination of vitamin C (1000 mg/day) and vitamin E (400 IU/day) on insulin sensitivity as measured by glucose infusion rates (GIR) during a hyperinsulinemic, euglycemic clamp in previously untrained (n = 19) and pretrained (n = 20) healthy young men. Before and after a 4 week intervention of physical exercise, GIR was determined, and muscle biopsies for gene expression analyses as well as plasma samples were obtained to compare changes over baseline and potential influences of vitamins on exercise effects. Exercise increased parameters of insulin sensitivity (GIR and plasma adiponectin) only in the absence of antioxidants in both previously untrained (P < 0.001) and pretrained (P < 0.001) individuals. This was paralleled by increased expression of ROS-sensitive transcriptional regulators of insulin sensitivity and ROS defense capacity, peroxisome-proliferator-activated receptor gamma (PPARγ), and PPARγ coactivators PGC1α and PGC1β only in the absence of antioxidants (P < 0.001 for all). Molecular mediators of endogenous ROS defense (superoxide dismutases 1 and 2; glutathione peroxidase) were also induced by exercise, and this effect too was blocked by antioxidant supplementation. Consistent with the concept of mitohormesis, exercise-induced oxidative stress ameliorates insulin resistance and causes an adaptive response promoting endogenous antioxidant defense capacity. Supplementation with antioxidants may preclude these health-promoting effects of exercise in humans.  If transient increases in oxidative stress are capable of counteracting insulin resistance in humans, it is possible that preventing the formation of ROS by, for example, antioxidants might actually increase, rather than decrease, the risk of type 2 diabetes. All larger intervention trials evaluating the diabetes-preventive potential of defined antioxidant supplements have been unable to find any positive effects of supplementation. Moreover, antioxidant use in type 2 diabetics has been linked to increased prevalence of hypertension and use of antioxidant supplements has recently been proposed to increase overall mortality in the general population. Taken together, these previously published findings tentatively suggest that fruits and vegetables may exert health-promoting effects despite their antioxidant content and possibly due to other bio-active compounds. However, it should be noted that the current study applied comparably high doses of oral antioxidants, which have been tested in healthy young men only.

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Exercise and genes:

The relationship between exercise and genes is bilateral:

1. Genes affect exercise behaviour:

2. Exercise affects gene’s behaviour:

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1. Genes affecting exercise behaviour:

Evidence suggests that our genes evolved to favor exercise. In other words, during prehistoric times, if a person couldn’t move quickly and wasn’t strong, that person died. Those who were fit survived to reproduce and pass on their “fitter” genes. Some researchers believe that with our current inactive lifestyle, these genes produce a number of bad effects, which can lead to many chronic illnesses.

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How genes and environment interact vis-à-vis exercise:

The predisposition to engage in voluntary exercise is complex and simultaneously effected by genetic architecture, the environment, and gene-environment and gene-gene interactions. Both genetic architecture and the environment are comprised of multiple components with the relative influence of each varying.

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A number of studies of both rodents and humans have demonstrated that individual differences in both ability and propensity for exercise (i.e., voluntary exercise) have some genetic basis. It has been well established that genetics plays an important role in regulation of voluntary activity levels and ability to respond to exercise training. Empirical support is rooted in the demonstration of heritability in humans, mice, and rats utilizing several different approaches. A study of 1022 pairs of twins estimated broad-sense heritability of total physical activity to be near 50%, and heritabilities of individual components of total activity (occupational, leisure time excluding sport, sport during leisure time) ranged from 40% to 65%. Additional human studies have estimated the heritability of physical activity to be anywhere between 18% and 92%, with variable environmental contributions. Perhaps the most convincing test of whether or not a trait, such as voluntary exercise behavior, exhibits significant narrow sense heritability is its response to direct selection. An ongoing artificial selection experiment for voluntary wheel running behavior in 4 replicate lines of mice resulted in a dramatic increases in activity. By generation 16, and continuing through generation 50 and beyond, the high-running (HR) lines had diverged significantly from the control lines with an approximate 3-fold increase in running on days 5 and 6 of a 6 day test. Narrow-sense heritability, representing the additive genetic component of phenotypic variation, was calculated to be 0.28. Given that exercise propensity has a heritable component and is an important component of positive health-related outcomes, investigations into the location or identity of specific genetic markers linked to exercise are becoming increasingly common.

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2. Exercise affecting gene’s behaviour:

Epigenetic regulation on gene expression induced by physical exercise:

It is well established that physical exercise modulates the function of many physiological systems, such as the musculoskeletal, the cardiovascular and the nervous system, by inducing various adaptations to the increased mechanical load and/or metabolic stress of exercise. Many of these changes occur through epigenetic alterations to DNA, such as histone modifications, DNA methylations, expression of microRNAs and changes of the chromatin structure. All these epigenetic alterations may have clinical relevance, thus playing an important role in the prevention and confrontation of neurophysiological disorders, metabolic syndrome, cardiovascular diseases and cancer.

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These epigenetic modifications are crucial for the activation of signalling cascades associated with genes that regulate metabolism and energy consumption in skeletal muscle. They also regulate numerous molecular pathways related to inflammatory processes. Moreover, some epigenetic modifications that possibly occur due to physical exercise can have a positive effect on restoring the genomic stability in cells with carcinogenesis potential, as well as on partially restoring age deregulated epigenetic patterns. Further insight into the epigenetic mechanisms involved in the aging process and their regulation by physical exercise might reveal ways in which exercise could be used as a preventive and/or complementary therapeutic strategy against age-related diseases. Furthermore, epigenetic alterations have a significant effect on the limbic system and especially on hippocampus, while the cardiovascular system is also affected by epigenetic changes caused by exercise, however, the evidence available for a clear association between them is not robust. It is suggested that exercise-related epigenetic changes could have an important role in preventing and/or confronting various disorders, such as metabolic or neurodegenerative diseases, that are either directly or indirectly associated with deregulation of normal epigenetic procedures and affect many people worldwide. Prof. Charlotte Ling and colleagues found that exercise brought about changes in 7,000 of the participants’ genes, i.e. 35% of their whole genetic makeup. They also noticed that fundamental genetic changes occurred which play a role in preventing obesity and type 2 diabetes.  A profound understanding of human epigenetic procedures during physical exercise could explain, in a more global and integrated approach, the possible cross talking between cascades which are involved in the regulation of human physiological systems. In this context, exercise remains an essential factor for promoting important biological adaptations that have profound implications for public health.

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Exercise and evolution:

Our ancestors were physically active not because they enjoyed exercise but because they needed to exercise. Early humans’ lifestyle demanded engagement in many energy-burning behaviors. The style of hunt-gathering life was composed of numerous physical activities (running to capture wounded prey, transporting children, building shelters) and social activities (visits to neighboring camps, dances as part of religious ceremonies or for recreation). As a response to this active lifestyle, an increase in aerobic and physical capacity allowed access to new food resources, influencing the development of brain components and consequently cognitive improvement in human. Bramble and Lieberman (2004) argue that our genus, Homo, evolved from more ape-like human ancestors, Australopithecus, 2 million or more years ago because natural selection favored the survival of australopithecines that could run and, over time, favored the perpetuation of human anatomical features that made long-distance running possible. Primate species with short toes are possibly best runners than those with longer toes, indicating an evolutionary adaptation to humans as good runners (Rolian et al., 2009). Another study shows that the gluteus maximus, muscle is also an adaptation to long-distance running, together with long legs and big buttocks in comparison with other primates. The reorganization of leg muscle anatomy in response to selective pressures on the environment over time was important to human pelvis development and bipedalism in order to increase the payoffs of foraging (Lieberman et al., 2006). Other researchers disagree with the notion that evolutionary selection pressure make us do exercise. According to them, there was never any evolutionary selection pressure to make us like exercise. Neanderthal or Homo erectus had to go long distances every day in order to survive. Not exercising was never an option, so there was never any selection pressure to make people like exercise. On the contrary, there was probably selection to help people avoid needless exercise when they could. Some hunter-gatherers had diets of about 2,200 calories a day. When your energy intake is that low, you can’t afford to go for a jog just for fun. According to them, evolution selected for traits that made us do no exercise and relax. When you walk into a train station and there is a staircase and an escalator, your brain always tells you to take the escalator.  It’s not in your best interest, but it’s probably a very deeply rooted evolutionary instinct. Nowadays due to lack of daily physical activity and overeating, this trait has become maladaptive. That is why we have to make conscious effort to exercise through some form of socially acceptable coercion.

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Exercise and evolution of brain:

The human brain is approximately three times larger than expected for our body size, due to increases in several brain components, including the frontal lobe, temporal lobe and cerebellum. This major increase in both absolute brain size and brain size relative to body mass occurred during the early evolution of the genus Homo, becoming especially pronounced during the evolution of Homo erectus. Because brain size changes in human evolution are often interpreted in the context of cognition, previous hypotheses for increased brain size in hominins have focused on greater social complexity or enhanced ecological demands on cognition. However, at the same time as brain size began to increase in the human lineage, aerobic activity levels appear to have changed dramatically. The hunting and gathering lifestyle adopted by human ancestors around 2 million years ago required a large increase in aerobic activity. High levels of physical activity altered the shape of the human body, enabling access to new food resources (e.g. animal protein) in a changing environment. Recent experimental work provides strong evidence that both acute bouts of exercise and long-term exercise training increase the size of brain components and improve cognitive performance in humans and other taxa. However, to date, researchers have not explored the possibility that the increases in aerobic capacity and physical activity that occurred during human evolution directly influenced the human brain. Researchers hypothesize that proximate mechanisms linking physical activity and neurobiology in living species may help to explain changes in brain size and cognitive function during human evolution. They review evidence that selection acting on endurance increased baseline neurotrophin and growth factor signalling (compounds responsible for both brain growth and for metabolic regulation during exercise) in some mammals, which in turn led to increased overall brain growth and development. This hypothesis suggests that a significant portion of human neurobiology evolved due to selection acting on features unrelated to cognitive performance.

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Exercise and health:

Health effects and benefits of exercise:

The landmark work by Morris and co-workers changed modern views of the relationship between physical activity, fitness, and health and inspired a new era in which the association between physical activity and human health, disease, and mortality was scrutinized scientifically. For more than half a century, a plethora of evidence has accumulated from large, long-term epidemiological studies that support a strong, inverse, and independent association between physical activity, health, and cardiovascular and overall mortality in apparently healthy individuals, and in patients with documented cardiovascular disease. The exercise-related health benefits are related in part to favorable modulations in both the traditional and novel cardiovascular risk factors that have been observed with increased physical activity patterns or structured exercise programs. The evidence for the health benefits of physical activity in adults is overwhelming. Being physically active plays an essential role in ensuring health and well-being, and there is a large body of research investigating the benefits of exercise.  Physical activity benefits many parts of the body – the heart, skeletal muscles, bones, blood (for example, cholesterol levels), the immune system and the nervous system – and can reduce many of the risk factors for non –communicable diseases NCDs. Regular physical activity reduces the risk of chronic diseases such as coronary artery disease, diabetes, and obesity. Regular physical activity also helps improve mental health, and there might be a dose-response relationship between mental health and the level and intensity of activity.

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Health benefits of exercise are divided in two groups:

Physical health benefits

Mental health benefits

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Physical Health Benefits of Exercise:

1. Weight loss and weight control

2. Increased muscle strength and muscle mass (which helps burn calories and fat)

3. Increased energy

4. Improved flexibility and movement

5. Lower risk of some types of cancer (Exercising at least 4 hours per week has been shown to lower risk of breast cancer by 37%!)

6. Reduced risk of Diabetes 2 and metabolic syndrome

7. Improved immune system, for overall better health

8. Increased “good” cholesterol to keep blood flowing smoothly

9. Lower risk of a heart attack and stroke

10. Helps smokers quit with higher success rates

11. Strength training & weight-bearing exercise (like walking, jogging, etc), promotes stronger bones (which is particularly helpful for women entering menopause, when bone density is lost)

12. In short, Exercise can increase your life expectancy by an average of 7 years! (One study in New England Journal of Medicine showed that asymptomatic women who weren’t fit had twice the risk of death than those who were fit!)

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Mental Health Benefits of Exercise:

Countless research studies show that exercise has incredible benefits not just for physical health, but for all areas of health, including mental, emotional, intellectual, and yes, even social well-being.

1. Regular aerobic exercise increases levels of seratonin and dopamine in the brain, which is linked with improved mood

2. Aerobic exercise increases endorphins in the brain, improving mood and energy

3. Exercise enhances the mind’s ability to withstand daily hassles and stressors and to regulate itself

4. Research shows exercise can alleviate symptoms of Pre-Menstrual Syndrome and Depression in women

5. Regular exercise has been shown equal to antidepressant use in treating Major Depressive Disorder

6. Exercise is associated with deeper relaxation and better quality of sleep (which protects the brain and increases energy)

7. Strength training has been shown to decrease tension and worry in the body and mind

8. Studies show exercise reduces/treats and may prevent anxiety and panic attacks

9. Exercise increases mental clarity and efficiency

10. Improves cognitive functioning in middle age and beyond

11. Exercise is associated with better thinking, learning, and judgment

12. It can help you tap into intuition and creativity

13. Exercise increases assertiveness and enthusiasm for life

14. Group or partner exercise increases social activity and decreases feelings of loneliness and isolation

15. Those who exercise regularly tend to have a better body-image

16. Regular exercise is associated with higher self-esteem

17. Overall, exercise is one of the best ways to improve happiness and life satisfaction

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Evidence for Health Benefits associated with Regular Physical Activity:

Children and Adolescents:

Strong evidence-

•Improved cardiorespiratory and muscular fitness

•Improved bone health

•Improved cardiovascular and metabolic health biomarkers

•Favorable body composition

Moderate evidence-

•Reduced symptoms of depression

Adults and Older Adults:

Strong evidence-

•Lower risk of early death

•Lower risk of coronary heart disease

•Lower risk of stroke

•Lower risk of high blood pressure

•Lower risk of adverse blood lipid profile

•Lower risk of type 2 diabetes

•Lower risk of metabolic syndrome

•Lower risk of colon cancer

•Lower risk of breast cancer

•Prevention of weight gain

•Weight loss, particularly when combined with reduced calorie intake

•Improved cardiorespiratory and muscular fitness

•Prevention of falls

•Reduced depression

•Better cognitive function (for older adults)

Moderate to strong evidence-

•Better functional health (for older adults)

•Reduced abdominal obesity

Moderate evidence-

•Lower risk of hip fracture

•Lower risk of lung cancer

•Lower risk of endometrial cancer

•Weight maintenance after weight loss

•Increased bone density

•Improved sleep quality

Note: The evidence of health benefits of physical activity are rated as strong, moderate, or weak. To do so, the number, and quality of studies available are considered, as well as consistency of findings across studies that addressed each outcome.

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There is incontrovertible evidence that regular physical activity contributes to the primary and secondary prevention of several chronic diseases and is associated with a reduced risk of premature death. There appears to be a graded linear relation between the volume of physical activity and health status, such that the most physically active people are at the lowest risk. However, the greatest improvements in health status are seen when people who are least fit become physically active.  Physical exercise is important for maintaining physical fitness and can contribute positively to maintaining a healthy weight, building and maintaining healthy bone density, muscle strength, and joint mobility, promoting physiological well-being, reducing surgical risks, and strengthening the immune system. Developing research has demonstrated that many of the benefits of exercise are mediated through the role of skeletal muscle as an endocrine organ. That is, contracting muscles release multiple substances known as myokines which promote the growth of new tissue, tissue repair, and multiple anti-inflammatory functions, which in turn reduce the risk of developing various inflammatory diseases.  Exercise reduces levels of cortisol which causes many health problems, both physical and mental. Conversely, exercise increases levels of saliva nitrite, which can be converted to the nitric oxide, thereby, increasing intensity and training load. Saliva testing for nitric oxide serves as a marker for training status.  Endurance exercise before meals lowers blood glucose more than the same exercise after meals. According to the World Health Organization, lack of physical activity contributes to approximately 17% of heart disease and diabetes, 12% of falls in the elderly, and 10% of breast cancer and colon cancer. There is evidence that vigorous exercise (60–85% of VO2 Max) induces a greater degree of physiological cardiac hypertrophy than moderate exercise (40 to 60% of VO2 Max), but it is unknown whether this has any effects on overall morbidity and/or mortality.  Both aerobic and anaerobic exercise work to increase the mechanical efficiency of the heart by increasing cardiac volume (aerobic exercise), or myocardial thickness (strength training). Ventricular hypertrophy, the thickening of the ventricular walls, is generally beneficial and healthy if it occurs in response to exercise. Not everyone benefits equally from exercise. There is tremendous variation in individual response to training; where most people will see a moderate increase in endurance from aerobic exercise, some individuals will as much as double their oxygen uptake, while others can never augment endurance.  However, muscle hypertrophy from resistance training is primarily determined by diet and testosterone. This genetic variation in improvement from training is one of the key physiological differences between elite athletes and the larger population. Studies have shown that exercising in middle age leads to better physical ability later in life.

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Exercise and mortality:

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Physical inactivity has been identified as the fourth leading risk factor for global mortality (6% of deaths globally). This follows high blood pressure (13%), tobacco use (9%) and high blood glucose (6%). Overweight and obesity are responsible for 5% of global mortality. Levels of physical inactivity are rising in many countries with major implications for the general health of people worldwide and for the prevalence of NCDs such as cardiovascular disease, diabetes and cancer and their risk factors such as raised blood pressure, raised blood sugar and overweight. Physical inactivity is estimated as being the principal cause for approximately 21–25% of breast and colon cancer burden, 27% of diabetes and approximately 30% of ischaemic heart disease burden. In addition, NCDs now account for nearly half of the overall global burden of disease. It is estimated currently that of every 10 deaths, 6 are attributable to noncommunicable conditions.

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Because of the many benefits for health of physical activity, recent analysis has suggested that reaching the recommended minimum level of physical activity compared with no activity was found to lead to a reduction in all-cause mortality of 19 per cent – and this rises to 24 per cent if an hour a day is spent in physical activity. In addition, there is a 31 per cent lower risk for all-cause mortality in active individuals. This demonstrates a positive dose-response – in other words, that the benefits of physical activity increase as the amount and intensity of the activity increases. Guidelines on physical activity and health from major health organizations have generally recommended exercise intensities in the range of 3 to 6 METs and an overall energy expenditure of at least 1000 kcal/wk (the equivalent of walking for roughly 30 minutes per day). This is based on a 20% to 40% reduction in mortality associated with increased physical activity patterns among middle-aged subjects followed for periods ranging between 5 and 15 years.  Similar to fitness levels, health outcome benefits from physical activity appear to be most dramatic at the lowest end of the activity spectrum and reach a plateau among the most highly active individuals (>3500 kcal/wk).

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The figure below shows exercise reduced relative risk of death:

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NIH study finds leisure-time physical activity extends life expectancy as much as 4.5 years:

Leisure-time physical activity is associated with longer life expectancy, even at relatively low levels of activity and regardless of body weight, according to a study by a team of researchers led by the National Cancer Institute (NCI), part of the National Institutes of Health.  The study, which found that people who engaged in leisure-time physical activity had life expectancy gains of as much as 4.5 years. In order to determine the number of years of life gained from leisure-time physical activity in adulthood, which translates directly to an increase in life expectancy, researchers examined data on more than 650,000 adults. These people, mostly age 40 and older, took part in one of six population-based studies that were designed to evaluate various aspects of cancer risk. The researchers also examined how life expectancy changed with the combination of both activity and obesity.  Obesity was associated with a shorter life expectancy, but physical activity helped to mitigate some of the harm.  People who were obese and inactive had a life expectancy that was between five to seven years shorter (depending on their level of obesity) than people who were normal weight and moderately active. According to data, a middle-aged person who gets the recommended 150 minutes per week of moderate exercise — defined as the level of brisk walking — can expect a 1-to-7 return: seven extra minutes of life gained for each minute spent exercising.

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Another study shows that life expectancy gains from physical activity:

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Elderly people who exercise ‘live five years longer’: 2015:

Regular exercise in old age has as powerful an effect on life expectancy as giving up smoking, researchers say. The analysis of 5,700 elderly men in Norway showed those doing three hours of exercise a week lived around five years longer than the sedentary. The authors, writing in the British Journal of Sports Medicine, called for campaigns to encourage fitness in older people.

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MZ twin-activity comparisons show high mortality component:

Table below is presented to show the mortality outcome in MZ twins discordant for physical activity in a large cohort of Swedish twins. The higher physically active MZ had a 36%–66% lower mortality than their inactive MZ pair.

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Tendency for dose-response between higher physical activity level and lower mortality in Swedish monozygotic twins:

Sex Physical activity level All-cause mortality Cardiovascular mortality
Hazard ratio 95% confidence intervals Hazard ratio 95% confidence intervals
Men Low 1 1
Moderate 0.84 0.72, 0.98 0.86 0.68, 1.08
High 0.64 0.50, 0.83 0.55 0.36, 085
Women Low 1 1
Moderate 0.82 0.70, 0.96 0.85 0.64, 1.13
High 0.75 0.50, 1.14 0.34 0.1,0.95

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Various studies and reviews regarding impact of exercise on health:

In many studies covering a wide range of issues, researchers have focused on exercise, as well as on the more broadly defined concept of physical activity. Exercise is a form of physical activity that is planned, structured, repetitive, and performed with the goal of improving health or fitness. So, although all exercise is physical activity, not all physical activity is exercise. Studies have examined the role of physical activity in many groups—men and women, children, teens, adults, older adults, people with disabilities, and women during pregnancy and the postpartum period. These studies have focused on the role that physical activity plays in many health outcomes, including:

•Premature (early) death;

•Diseases such as coronary heart disease, stroke, some cancers, type 2 diabetes, osteoporosis, and depression;

•Risk factors for disease, such as high blood pressure and high blood cholesterol;

•Physical fitness, such as aerobic capacity, and muscle strength and endurance

•Functional capacity (the ability to engage in activities needed for daily living);

•Mental health, such as depression and cognitive function; and

•Injuries or sudden heart attacks.

These studies have also prompted questions as to what type and how much physical activity is needed for various health benefits.

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Major Research Findings of various studies on the health benefits of Physical Activity:

•Regular physical activity reduces the risk of many adverse health outcomes.

•Some physical activity is better than none.

•For most health outcomes, additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration.

•Most health benefits occur with at least 150 minutes a week of moderate-intensity physical activity, such as brisk walking. Additional benefits occur with more physical activity.

•Both aerobic (endurance) and muscle-strengthening (resistance) physical activity are beneficial.

•Health benefits occur for children and adolescents, young and middle-aged adults, older adults, and those in every studied racial and ethnic group.

•The health benefits of physical activity occur for people with disabilities.

•The benefits of physical activity far outweigh the possibility of adverse outcomes.

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Overview of Evidence for improvement in health due to exercise:

Condition Evidence for improvement, and scale of improvement with physical activity
Short term improvements Many papers report global improvements in health across a range of conditions.  Physical activity helps to manage over 20 chronic conditions, including coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions.
COPD Physical activity improves cardiorespiratory health. Furthermore, in COPD, exercise training reduces dyspnoea symptoms and increases ability for exertion.
Heart disease and/ or Heart failure and/or Angina All studies show clear improvements in cardiovascular health with moderate exercise. There are similar beneficial effects for sufferers of angina. Overall, exercise reduces cardiac mortality by 31%.
Hypertension (high blood pressure) Hypertension is very common with 30% of adults having this diagnosis. Hypertension is responsible for 50% of strokes and 50% of Ischaemic heart disease.  Most people with hypertension are on long-term medication. Randomised controlled trials show a clear lowering of blood pressure with aerobic training. The scale of the reduction has been quantified:  31% of patients on average experience a drop of at least 10 mmHg with regular physical activity.
Cholesterol Across several studies, exercise led to a reduction in LDL by an average of 1 to 2mmol/l and an increase in “good” High Density Lipoprotein (HDL).
Obesity Exercise only has a moderate effect in reducing obesity. Aerobic physical activity has a consistent effect on achieving weight maintenance.  Exercise also changes the distribution of fat, by reducing the less healthy visceral [abdominal] fat – for some individuals the body weight may stay the same as muscle is built up but the reduction in visceral fat is highly beneficial for health.
Depression There has been a wealth of evidence on the effect of exercise in the treatment of depression, most showing positive outcome.  An updated Cochrane review evaluated 30 trials of physical activity as a treatment for depression, showing overall  ‘moderate’ improvement.
Peripheral vascular disease Exercise leads to a moderate improvement in peripheral vascular disease. Improvements are seen in both pain-free walking time and distance in several studies.
Diabetes Exercise has a statistically and clinically significant beneficial effect on glycemic control and the metabolic state. Exercise works as a treatment modality in both type 1 and type 2 diabetes.
Osteoarthritis  Joints / Low back pain  / osteoporosis Osteoarthritis is sometimes thought to be related to “wear and tear” yet physical activity improves symptoms of osteoarthritis by 22-83% and does not lead to worsening of this condition. It has benefits in reducing pain (by 25-52%), improving function, improving quality of life and mental health.  Others have commented on exercise being weakly effective in osteoarthritis and leading to moderate improvement in low back pain. Exercise increases muscle strength and coordination.
Chronic pain Exercise leads to improvement in pain conditions by 25 -52%.
Fibromyalgia and fatigue Aerobic exercise improves physical function and well-being in fibromyalgia. It can also reduce the symptom of fatigue seen in different conditions.
Cancer There are few studies looking at exercise as a treatment for cancer, and effects would be expected to vary by type of cancer. In prostate cancer, a 57% lower rate of cancer progression was found with exercise. Exercise helps with side-effects of treatment, improves mood, fatigue and stamina and probably prolongs life.
Dementia Physical exercise improves cognitive function and consistently reverses brain atrophy. A significant relationship between physical activity training and improved cognition was obtained for both normal adults and patients with early signs of Alzheimer’s disease, in which memory or cognitive ability was mildly impaired. Some studies lament the paucity of case-control studies for exercise in people with established dementia, but all show “strong indications of benefits” in well-being, quality of life, improved balance and strength with reduced falls and more prolonged independence.

It should be noted that these effects occur at low levels of activity – 30 minutes, 5 times per week. The largest health gains occur in people moving from inactive to moderately inactive and from moderately inactive to moderately active. The effects work by different mechanisms. In patients with multiple co-morbidities, physical activity can improve several conditions in different ways. The benefits of physical activity work independently from those of weight change. Increasing ‘fitness’ works in a different way to reducing ‘fatness’  so even people who are overweight can improve their metabolic health by exercising, even if they don’t necessarily lose weight.

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Classification of physical activities vis-à-vis health benefits:

As you can see in the table above, substantial health benefits are rendered if medium level of physical activity is performed i.e. 150 to 300 minutes of moderate intensity exercise per week.

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Long-term health benefits of physical activity – a systematic review of longitudinal studies: 2013:

The purpose of this review is to summarize existing evidence for the long-term (>5 years) relationship between physical activity and weight gain, obesity, coronary heart disease, type 2 diabetes mellitus, Alzheimer’s disease and dementia. Fifteen longitudinal studies with at least 5-year follow up times and a total of 288,724 subjects (>500 participants in each study), aged between 18 and 85 years, were identified using digital databases. Only studies published in English, about healthy adults at baseline, intentional physical activity and the listed NCDs were included. The results of these studies show that physical activity appears to have a positive long-term influence on all selected diseases.

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Intensity vs. duration of exercise:

The independent effects of exercise type, volume, and intensity on the risk for coronary heart disease (CHD) have been assessed in a large cohort of men (n=44 452) enrolled in the Health Professionals’ Follow-up Study. Walking pace (intensity) and exercise duration were both inversely related to the risk of CHD independent of walking volume. However, the much stronger association between exercise intensity and risk suggests that exercise intensity has a more significant effect on the incidence of CHD than duration. This was also the first study to provide evidence for the efficacy of resistance training on CHD risk. The reduction in CHD risk achieved by participation in resistance training was similar to that provided by brisk walking and rowing but was approximately half of that provided by running. Similarly, in the Women’s Health Study, exercise intensity (walking pace) and duration of walking were both inversely and independently related to the risk of coronary events. Women who walked 1 to 3 hours per week had between 30% and 50% reductions in CHD events compared with women who did no walking. However, for the same exercise volume achieved by either higher exercise intensity or longer duration, the risk reduction was substantially greater for exercise duration. In contrast to the findings reported in the Health Professionals’ Follow-up Study of men, this suggests that exercise duration is more effective in lowering the risk for coronary events than exercise intensity. However, the inextricable complexity of the interactions between gender, exercise intensity, duration, and frequency cannot be resolved by epidemiological studies. Most importantly, and despite possible differences attributable to gender and exercise stimulus, the salient finding of these and other reports is that moderate activity such as walking has a considerable impact on CHD events, and walking or similar activities a few hours per week should be recommended to all adults, as suggested in various guidelines.

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Exercise and diseases:

Regular physical activity using large muscle groups, such as walking, running, or swimming, produces cardiovascular adaptations that increase exercise capacity, endurance, and skeletal muscle strength. Habitual physical activity also prevents the development of coronary artery disease (CAD) and reduces symptoms in patients with established cardiovascular disease. There is also evidence that exercise reduces the risk of other chronic diseases, including type 2 diabetes, osteoporosis, obesity, depression, and cancer of the breast and colon. This American Heart Association (AHA) Scientific Statement for health professionals summarizes the evidence for the benefits of physical activity in the prevention and treatment of cardiovascular disease, provides suggestions to healthcare professionals for implementing physical activity programs for their patients, and identifies areas for future investigation. This statement focuses on aerobic physical activity and does not directly evaluate resistance exercises, such as weight lifting, because most of the research linking physical activity and cardiovascular disease has evaluated aerobic activity. Whenever possible, the writing group has cited summary articles or meta-analyses to support conclusions and recommendations. This evidence supports the recommendation from the Center for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) that individuals should engage in 30 minutes or more of moderate-intensity physical activity on most (preferably all) days of the week.

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Benefits of Exercise:

Almost all patients benefit from physical activity, but some require risk stratification. Increasing physical activity is effective in the treatment and prevention of chronic disease and improving overall health and well -being.

Research has found that people who do regular physical activity have:

•up to a 35% lower risk of coronary heart disease and stroke

•up to a 50% lower risk of type 2 diabetes

•up to a 50% lower risk of colon cancer

•up to a 20% lower risk of breast cancer

•a 30% lower risk of early death

•up to an 83% lower risk of osteoarthritis

•up to a 68% lower risk of hip fracture

•a 30% lower risk of falls (among older adults)

•up to a 30% lower risk of depression

•up to a 30% lower risk of dementia

•up to a 50 % lower risk of high blood pressure

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How does physical activity and fitness lead to improved health outcomes?

Several biological mechanisms may be responsible for the reduction in the risk of chronic disease and premature death associated with routine physical activity. For instance, routine physical activity has been shown to improve body composition (e.g., through reduced abdominal adiposity and improved weight control), enhance lipid lipoprotein profiles (e.g., through reduced triglyceride levels, increased high-density lipoprotein [HDL] cholesterol levels and decreased low-density lipoprotein [LDL]-to-HDL ratios), improve glucose homeostasis and insulin sensitivity,  reduce blood pressure, improve autonomic tone, reduce systemic inflammation;  decrease blood coagulation, improve coronary blood flow, augment cardiac function and enhance endothelial function. Chronic inflammation, as indicated by elevated circulating levels of inflammatory mediators such as C-reactive protein, has been shown to be strongly associated with most of the chronic diseases whose prevention has benefited from exercise. Recent RCTs have shown that exercise training may cause marked reductions in C-reactive protein levels.  Each of these factors may explain directly or indirectly the reduced incidence of chronic disease and premature death among people who engage in routine physical activity.

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Now let me discuss some important diseases vis-à-vis exercise:

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Cancer:

Exercise improves quality of life in cancer patients as seen in the figure below:

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The graphic below from the American Institute for Cancer Research visually depicts the importance of both daily physical activity and structured exercise (in relation to cancer indicators). Here, the green reflects structured exercise, while the yellow reflects daily physical activity.

This shows that even though structured moderate exercise volume remains same, reduced daily physical activity increases cancer risk.

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A systematic review evaluated 45 studies that examined the relationship between physical activity and cancer survivorship. According to the study results “There was consistent evidence from 27 observational studies that physical activity is associated with reduced all-cause, breast cancer–specific, and colon cancer–specific mortality”.

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Cancer cachexia:

Physical exercise is becoming a widely accepted non-pharmacological intervention for the prevention and attenuation of cancer cachexia. Cachexia is a multiorganic syndrome associated with cancer, characterized by inflammation, body weight loss (at least 5%) and muscle and adipose tissue wasting. The exercise-induced transcription coactivator peroxisome proliferator-activated receptor-γ coactivator 1α (PGC1α), which suppresses FOXO and NF-κB dependent transcription during atrophy induced by fasting or denervation, may be a key intermediate responsible for the beneficial antiatrophic effects of physical exercise on cancer cachexia. The exercise-induced isoform PGC1α4, which can repress myostatin and induce IGF1 and hypertrophy, is a potential drug target for treatment of cancer cachexia. Other factors, such as JUNB and SIRT1, that maintain skeletal muscle mass and promote hypertrophy are also induced with regular physical exercise.

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How might physical activity affect cancer survivorship?

Research indicates that physical activity after a diagnosis of breast cancer may be beneficial in improving quality of life, reducing fatigue, and assisting with energy balance. Both reduced physical activity and the side effects of treatment have been linked to weight gain after a breast cancer diagnosis. One study found that women who exercised moderately (the equivalent of walking 3 to 5 hours per week at an average pace) after a diagnosis of breast cancer had improved survival rates compared with more sedentary women. The benefit was particularly pronounced in women with hormone responsive tumors. Another study found that a home-based physical activity program had a beneficial effect on the fitness and psychological well-being of previously sedentary women who had completed treatment for early-stage through stage II breast cancer. Increasing physical activity may influence insulin and leptin levels and influence breast cancer prognosis. Although there are several promising studies, it is too early to draw any strong conclusions regarding physical activity and breast cancer survival.

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Two additional studies have suggested a protective association of physical activity after colon cancer diagnosis and survival. Researchers examined the relationship between levels of physical activity both before and after a diagnosis of colon cancer in two different observational studies. Whereas levels of pre-diagnosis physical activity were not related to survival, participants with higher levels of physical activity post-diagnosis were less likely to have a cancer recurrence and had increased survival. Although these studies suggest protective effects of physical activity, more research is needed to understand what levels of physical activity provide these benefits.

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Cardiovascular system:

The beneficial effect of exercise on the cardiovascular system is well documented. There is a direct relation between physical inactivity and cardiovascular mortality, and physical inactivity is an independent risk factor for the development of coronary artery disease. There is a dose-response relation between the amount of exercise performed from approximately 700 to 2000 kcal of energy expenditure per week and all-cause mortality and cardiovascular disease mortality in middle-aged and elderly populations. The greatest potential for reduced mortality is in the sedentary who become moderately active. Most beneficial effects of physical activity on cardiovascular disease mortality can be attained through moderate-intensity activity (40% to 60% of maximal oxygen uptake, depending on age).  Persons who modify their behavior after myocardial infarction to include regular exercise have improved rates of survival. … Persons who remain sedentary have the highest risk for all-cause and cardiovascular disease mortality.

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A sedentary lifestyle is one of the major risk factors for cardiovascular disease, as outlined by the AHA. Evidence from many scientific studies shows that reducing this risk factors decreases the chance of having a heart attack or experiencing another cardiac event, such as a stroke, and reduces the possibility of needing a coronary revascularization procedure (bypass surgery or coronary angioplasty). Regular exercise has a favorable effect on many of the established risk factors for cardiovascular disease. For example, exercise promotes weight reduction and can help reduce blood pressure. Exercise can reduce “bad” cholesterol levels in the blood (the low-density lipoprotein [LDL] level), as well as total cholesterol, and can raise the “good” cholesterol (the high-density lipoprotein level [HDL]). In diabetic patients, regular activity favorably affects the body’s ability to use insulin to control glucose levels in the blood. Although the effect of an exercise program on any single risk factor may generally be small, the effect of continued, moderate exercise on overall cardiovascular risk, when combined with other lifestyle modifications (such as proper nutrition, smoking cessation, and medication use), can be dramatic.

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How much Exercise does it take to lower Cholesterol?

Exactly how much exercise is needed to lower cholesterol has been a matter of some debate. In general, most public health organizations recommend, at a minimum, 30 minutes per day of moderate to vigorous exercise, such as walking, jogging, biking, or gardening. But a 2002 study by researchers at Duke University Medical Center found that more intense exercise is actually better than moderate exercise for lowering cholesterol. In a study of overweight, sedentary people who did not change their diet, the researchers found that those who got moderate exercise (the equivalent of 12 miles of walking or jogging per week) did lower their LDL level somewhat. But the people who did more vigorous exercise (the equivalent of 20 miles of jogging a week) lowered it even more. The people who exercised vigorously also raised their levels of high-density lipoprotein (HDL) — the “good” kind of lipoprotein. According to Kraus’s findings, however, even though moderate exercise was not as effective in reducing LDL or increasing HDL, it did keep cholesterol levels from rising. The exercise volume for achieving significant HDL cholesterol changes is estimated at ≈1000 to 1500 kcal/wk. This parallels an earlier study in which a mean estimated weekly energy expenditure of 1245 kcal for individuals running ≈7 to 10 miles per week (average, 9 miles) and 1688 kcal for those running 11 to 14 miles per week (average, 12 miles) resulted in 7% and 11% increases in HDL cholesterol concentrations, respectively.  Others have reported similar changes in HDL cholesterol among individuals running similar weekly distances for ≈9 to 12 months. It is likely that other modes of physical activity will invoke similar increases in HDL cholesterol concentrations as long as they meet or exceed the caloric expenditure of 1200 to 1600 kcal.

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Epidemiological evidence of exercise benefits:

Studies have linked sedentary living with high rates of coronary heart disease mortality. One study found that San Francisco longshoremen who worked in jobs requiring high levels of energy expenditure had less risk of dying of heart disease than did longshoremen who performed sedentary jobs. This study showed that dockworkers and cargo handlers expended at least 1,000 kilocalories more per day than did clerks and foremen and that sedentary workers, during a 22-year observation, were about twice as likely to die from heart disease. The higher risk of death in the less active men was not due to other coronary heart disease risk factors, such as smoking, obesity, and high blood pressure; nor was it the result of less healthy men’s shifting to sedentary jobs. Another study followed the health status of approximately 17,000 male graduates of Harvard University for many years. All these men essentially had sedentary jobs, but they differed in the amount of leisure time they spent on physical activities. Men who expended at least 2,000 kilocalories per week on physical activity had only half the death rate from heart disease as did those men who expended less than 500 kilocalories per week. Not all of this energy was spent in exercise programs; some was expended during routine activities such as climbing stairs.

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Primary prevention of cardiovascular disease:

Since the seminal work of Morris and colleagues in the 1950s and the early work of Paffenbarger and colleagues in the 1970s, there have been numerous long-term prospective follow-up studies (mainly involving men but more recently women also) that have assessed the relative risk of death from any cause and from specific diseases (e.g., cardiovascular disease) associated with physical inactivity. Both men and women who reported increased levels of physical activity and fitness were found to have reductions in relative risk (by about 20%–35%) of death. For example, in a study involving healthy middle-aged men and women followed up for 8 years, the lowest quintiles of physical fitness, as measured on an exercise treadmill, were associated with an increased risk of death from any cause compared with the top quintile for fitness. Recent investigations have revealed even greater reductions in the risk of death from any cause and from cardiovascular disease. For instance, being fit or active was associated with a greater than 50% reduction in risk.  Furthermore, an increase in energy expenditure from physical activity of 1000 kcal (4200 kJ) per week or an increase in physical fitness of 1 MET (metabolic equivalent) was associated with a mortality benefit of about 20%. Physically inactive middle-aged women (engaging in less than 1 hour of exercise per week) experienced a 52% increase in all-cause mortality, a doubling of cardiovascular-related mortality and a 29% increase in cancer-related mortality compared with physically active women. These relative risks are similar to those for hypertension, hypercholesterolemia and obesity, and they approach those associated with moderate cigarette smoking. Moreover, it appears that people who are fit yet have other risk factors for cardiovascular disease may be at lower risk of premature death than people who are sedentary with no risk factors for cardiovascular disease.  An increase in physical fitness will reduce the risk of premature death, and a decrease in physical fitness will increase the risk.  The effect appears to be graded, such that even small improvements in physical fitness are associated with a significant reduction in risk. A recent systematic review of the literature regarding primary prevention in women revealed that there was a graded inverse relation between physical activity and the risk of cardiovascular-related death, with the most active women having a relative risk of 0.67 (95% CI 0.52 to 0.85) compared with the least active group. These protective effects were seen with as little as 1 hour of walking per week. In summary, observational studies provide compelling evidence that regular physical activity and a high fitness level are associated with a reduced risk of premature death from any cause and from cardiovascular disease in particular among asymptomatic men and women. Furthermore, a dose– response relation appears to exist, such that people who have the highest levels of physical activity and fitness are at lowest risk of premature death.

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30 minute of Exercise per day not enough to prevent Heart failure: a 2015 study:

In the latest study, Jarett Berry, associate professor of medicine and clinical sciences at University of Texas Southwestern Medical Center, and his colleagues studied how exercise can affect risk of heart failure. They report in the journal Circulation on how much physical activity is needed to effectively lower risk of the condition. Berry and his team analyzed responses from 12 large studies involving 370,460 people who were asked about their exercise habits and followed on average for 13 years. Berry found that those who were the most physically active showed a 30% lower risk of having heart failure than those who exercise the least. These people got more activity than what the government currently recommends, which is 150 minutes of moderate physical activity each week. The people who exercise that much also lowered their risk of heart failure, but not by as much: a 15% to 22% drop. In fact, people who doubled the recommended level of activity lowered their risk of heart failure by 19% while those who quadrupled the amount of exercise reduced their risk by 35%. So higher dose of exercise is not a waste of time in preventing heart failure. Berry stresses that while the people who exercised more clearly derived more benefit from the activity, any amount of exercise is still helpful. Compared to people who were not active at all, those who followed the recommended 150 minutes of activity a week lowered their risk of heart failure by 10%. The findings do suggest, however, that exercise advice to lower heart failure may be different from recommendations for reducing heart attacks and stroke. That may be because the two categories of heart problems are caused by different factors. The study alone won’t be enough to change the recommendations for heart failure patients, and Berry notes that it highlights a possible connection between exercise and heart failure.

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Secondary prevention of cardiovascular disease:

The benefits of physical activity and fitness extend to patients with established cardiovascular disease. This is important because, for a long time, rest and physical inactivity had been recommended for patients with heart disease. Unlike studies of primary prevention, many studies of secondary prevention are RCTs. Several systematic reviews have clearly shown the importance of engaging in regular exercise to attenuate or reverse the disease process in patients with cardiovascular disease. For instance, a systematic review and meta-analysis of 48 clinical trials revealed that, compared with usual care, cardiac rehabilitation significantly reduced the incidence of premature death from any cause and from cardiovascular disease in particular. An energy expenditure of about 1600 kcal (6720 kJ) 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 plaque reduction in patients with heart disease.  Low-intensity exercise training (e.g., exercise at less than 45% of maximum aerobic power) has also been associated with an improvement in health status among patients with cardiovascular disease.  However, the minimum training intensity recommended for patients with heart disease is generally 45% of heart rate reserve. In summary, regular physical activity is clearly effective in the secondary prevention of cardiovascular disease and is effective in attenuating the risk of premature death among men and women.

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Effects of Exercise on Heart Failure:

Activity restriction was recommended for heart failure (HF) patients until the late 1970s and 1980s, when it was recognized that exercise capacity in patients with left ventricular dysfunction could not be predicted by such parameters as intracardiac filling pressures and left ventricular ejection fraction. Numerous trials have demonstrated that both exercise testing and training of patients with HF appear to be safe. Exercise training benefits HF in several ways. The mean increase in peak VO2 in 15 randomized controlled trials of exercise training that included 426 HF patients was 20.5%. The frequency, duration, and intensity varied among the trials, but all showed an increase in the average peak VO2 between 12% and 31%.  In addition to improving exercise capacity, exercise training in HF patients has been shown to improve cardiac output at maximal workloads, improve mitochondrial size and density, increase skeletal muscle oxidative enzymes, reduce endothelial dysfunction, and decrease circulating catecholamines. Exercise training has also been shown to improve quality of life in both men and women with moderate, chronic HF. Whether these physiological adaptations will ultimately reduce mortality and morbidity is yet to be determined by a large prospective trial, although there is at least one small trial which showed a reduction in hospitalizations and improved 1-year survival.

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Hypertension:

The high prevalence of hypertension (estimated to be one third of the adult population) is due in part to lifestyle factors. Positive lifestyle modifications, including weight loss and increased physical activity, contribute significantly to BP control. Significant reductions in BP after aerobic exercise programs of mild to moderate intensity have been a consistent finding of many well-controlled studies. At least 44 randomized controlled trials including 2674 participants have studied the effect of exercise training on resting blood pressure. The average reduction in systolic and diastolic blood pressure was 3.4 and 2.4 mm Hg, respectively. Baseline blood pressure was an important determinant of the exercise effect. Average systolic and diastolic blood pressures decreased 2.6 and 1.8 mm Hg in normotensive subjects and 7.4 and 5.8 mm Hg in hypertensive subjects, respectively, suggesting that exercise may serve as the only therapy required in some mildly hypertensive subjects. There was no relationship between the weekly training frequency, time per session, or intensity of exercise training and the magnitude of the blood pressure reduction, which suggests that the dose-response curve for exercise and blood pressure is flat. Consequently, increased physical activity is now strongly recommended as part of the lifestyle modifications as an adjunct to pharmacological therapy proposed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and recent European Society of Hypertension/European Society of Cardiology guidelines.

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Resistance Exercise and Hypertension:

Strength training as a way to lower BP was traditionally discouraged by physicians and other health professionals largely because excessive elevations in BP have been noted during high-resistance weight-lifting exercises.  However, resistance training has been widely recommended in recent years for the elderly, in cardiac rehabilitation programs, and for the public because it is associated with numerous health benefits, including reducing the risk of falls by reversing or attenuating the age-related decline in bone mineral density, muscle mass, and power. Information available on the effects of strength training on resting BP is limited and conflicting. The conclusion of a recent meta-analysis was that the average systolic BP reduction as a result of resistance training was ≈3 mm Hg. This is substantially less than that reported for endurance exercise.  Consequently, the recommendation of the American College of Sports Medicine is for resistance training to serve as an adjunct to an aerobic-based exercise program for BP reduction.  Despite the limited favorable changes in BP, strength training is associated with numerous other health benefits, and in accordance with recommendations from the American Heart Association and the American College of Sports Medicine, resistance exercise should be implemented as part of a complete exercise program.

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If you have high blood pressure, your doctor or nurse may suggest that you try to become more active to lower it. However, you may be worried that regular exercise will increase your blood pressure to dangerous levels. It is true that physical activity (exercise) will cause your blood pressure to rise for a short time. However, when you stop the activity, your blood pressure should soon return to normal. The quicker it does this, the fitter you are likely to be. Most people with high blood pressure should be able to increase their physical activity levels quite safely.  However, if your blood pressure is relatively high, your doctor or nurse may prefer to lower it with medicines before starting you on an exercise programme. If your blood pressure is very high, you should not start any new activity without consulting your doctor. Everyone, especially people with high blood pressure, should breathe as normally as possible through each exercise. Holding your breath increases blood pressure. The table below gives a general idea of what levels you need to be concerned about, but bear in mind that every person is different, and your doctor or nurse may decide differently.

Blood pressure level General ability to be more active
Below 90/60 You may have low blood pressure, speak to your doctor or nurse before starting any new exercise
90/60-140/90 It is safe to be more active, and it will help to keep your blood pressure in this ideal blood pressure range
140/90 – 179/99 It should be safe to start increasing your physical activity to help lower your high blood pressure
180/100 – 199/109 Speak to your doctor or nurse before starting any new exercise
200/110 or above Do not start any new activity – speak to your doctor or nurse

To be safe, it is always a good idea to get advice from your doctor or nurse before you start any new physical activity. In moderately severe and severe hypertension (diastolic blood pressure values in excess of 105mm Hg), sporting activities and endurance training are contraindicated till blood pressure is controlled by drugs.

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Management of Hypertension in Actively Exercising Patients:

In general, rises in systolic blood pressure to over 200mm Hg during exercise with a workload of 100W are regarded as pathological. Excessive exercise blood pressure values are to be expected in principle in all hypertensives. However, there are so far no generally accepted criteria for diagnosis of isolated systolic exercise hypertension (with normal values of resting blood pressure). The incidence of isolated systolic exercise hypertension is estimated to be about 10% of a selected population. In patients with excessive rises in blood pressure during exercise who want to engage actively in sport, general measures (reduction of obesity, restriction of alcohol and salt intake) and endurance training should be recommended initially. For endurance training, sporting activities that involve dynamic exercise are to be recommended (walking, running, mountain hiking, cycling, swimming, cross-country skiing). Activities involving isometric exercise (rowing, diving, tennis) and sport of a competitive nature are not suitable.

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Effects of Exercise on Stroke:

Physical activity lowers stroke risk. All stroke survivors should have a medical evaluation before starting an exercise program. The effects of exercise on stroke are less established than those on heart disease, but most studies show benefits.

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Diabetes mellitus:

For improving blood sugar control, the American Diabetes Association recommends at least 150 minutes per week of moderate-intensity aerobic physical activity (50 – 70% of maximum heart rate) or at least 90 minutes per week of vigorous aerobic exercise (more than 70% of maximum heart rate). Exercise at least 3 days a week, and do not go more than 2 consecutive days without physical activity. Strength training, which increases muscle and reduces fat, is also helpful for people with diabetes who are able to do this type of exercise. The American Diabetes Association recommends performing resistance exercise three times a week. Build up to three sets of 8 – 10 repetitions using weight that you cannot lift more than 8 – 10 times without developing fatigue. Be sure that your strength training targets all of the major muscle groups.

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Evidence of exercise benefit in diabetes:

A review of 9 trials examining the effect of exercise training in 337 patients with type II diabetes reported an average reduction ofnA1c of 0.5% to 1%. These findings may underestimate the absolute decrease in A1C because of concomitant reductions in diabetic medications. Evidence from large cohort studies demonstrates that physical activity in general provides a highly effective way to delay or avert the development of diabetes mellitus. In addition, physical activity has been shown to reduce the risk of mortality in diabetics. The incidence of type 2 diabetes mellitus was inversely related to leisure time physical activity among men in the Harvard Alumni Study and in US male physicians. Likewise, in the Nurses’ Health Study60 (n=70), the relative risk for developing diabetes mellitus in women was inversely related to the level of fitness as well as exercise volume and intensity in a dose-response fashion. Equivalent energy expenditures from different activities and intensities conferred similar health benefits. These epidemiological findings are supported by 2 interventional studies. In the Finnish Diabetes Prevention Study, 522 middle-aged, overweight men and women were randomized to either an intervention group or a control group. The intervention group was counselled to follow a healthy diet, reduce weight, and increase physical activity. At the end of 3.2 years of follow-up, the cumulative incidence of diabetes mellitus was 11% for the intervention group and 23% for the control group. The overall risk for diabetes mellitus was reduced by 58% in the intervention group. The Diabetes Prevention Program Research Group Study provided strong evidence that lifestyle modifications, including diet and exercise, were more effective in reducing the incidence of diabetes than treatment with metformin. Compared with the control group, the incidence of diabetes mellitus was 58% lower in the lifestyle-intervention group encouraged to exercise 150 min/wk and 31% in the metformin group. The incidence of diabetes mellitus was 39% lower in the lifestyle-intervention group than in the metformin group. To prevent 1 case of diabetes mellitus, the investigators calculated that 6.9 persons would have to participate in the lifestyle-intervention group and 13.9 would have to receive metformin. Finally, lifestyle intervention resulted in more participants maintaining normal blood glucose values over a period of 3 years compared with the metformin or placebo group. Evidence also suggests that the all-cause mortality risk in physically unfit or sedentary diabetics is >2 times higher compared with physically fit men and women diabetics regardless of body weight. Because blacks have a 2- to 6-fold higher risk for developing diabetes mellitus and approximately double the diabetes mellitus death rate compared with whites, the relationship between exercise capacity and all-cause mortality in black and white diabetic individuals was assessed in the Veterans Exercise Testing Study. The findings support the concept that exercise capacity is a strong predictor of mortality in black and white men with type 2 diabetes mellitus. The age-adjusted reduction was graded and more pronounced in whites than in blacks; each 1-MET increase in exercise capacity yielded 14% and a 19% lower risk for blacks and whites, respectively Similarly, the risks were 34% and 46% lower for moderately and highly fit blacks versus blacks in the low-fitness category, respectively. For whites, the comparable reductions were 43% and 67%, respectively.

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Physical activity activates has acute and chronic effects on glucose, lipid and protein metabolism. In type 1 diabetic subjects, the lack of the physiological inhibition of insulin secretion during exercise results in a potential risk of hypoglycemia. On the other hand, exercise-induced activation of counterregulatory hormones might trigger an acute metabolic derangement in severe insulin-deficient subjects. Thus, diabetic patients, before starting exercise sessions, must be carefully educated about the consequences of physical activity on their blood glucose and the appropriate modifications of diet and insulin therapy. Long-term effects of regular exercise are particularly advantageous for type 2 diabetic patients. Regular aerobic exercise reduces of visceral fat mass and body weight without decreasing lean body mass, ameliorates insulin sensitivity, glucose and blood pressure control, lipid profile and reduces the cardiovascular risk. For these reasons, regular aerobic physical activity must be considered an essential component of the cure of type 2 diabetes mellitus. In this regard, individual behavioral strategies have been documented to be effective in motivating sedentary type 2 diabetic subjects to the adoption and the maintenance of regular physical activity.

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The rulebook of physically active insulin-treated diabetic subjects:

1. Inject regular insulin or fast-acting insulin analogues into abdominal subcutaneous region

2. Cut regular insulin or fast-acting insulin dosage by 10-40% before the exercise, dependent on duration and intensity of the session

3. Plan to exercise 3-4 hours after the injection of regular insulin or 2 hours after the injection of fast-acting insulin analogue

4. Before starting the exercise session, check your blood glucose

5. Before starting, ingest 20-60 g of simple carbohydrates if your blood glucose is less than 120 mg%

6. Before starting, delay the exercise session if your blood glucose is less than 80 mg%

7. Before starting, delay the exercise session if your blood glucose is greater than 250 mg%; you can exercise only if your blood or urinary ketones are negative

8. During exercise of moderate (60-75% maximal heart rate) or higher intensity supplement with 20-60 g of simple carbohydrates, every 30 minutes

9. Check your blood glucose after 30 minutes of exercise

10. After exercise, cut your usual pre-meal regular insulin or fast-acting insulin dosage by 10-30%

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Exercises to avoid when you have Diabetes:

Regular physical activity is an important part of a healthy lifestyle when you have diabetes. It is good for your cardiovascular system and can help control blood glucose levels. However, there are times when you need to be careful about exercising with diabetes.  If you have certain diabetes complications, there are exercises that you should avoid. The following complications may affect your exercise routine:

1. Proliferative diabetic retinopathy (PDR)—Patients with diabetes and active PDR should avoid activities that involve strenuous lifting; harsh, high-impact activities; or placing the head in an inverted position for extended periods of time.

2. Diabetic peripheral neuropathy— Diabetic peripheral neuropathy may result in loss of sensation and position awareness of your feet. Repetitive exercise on insensitive feet can lead to ulceration and fractures.

3. Advanced kidney disease— Individuals with diabetes and advanced kidney disease can engage in moderate intensity activities, but should avoid strenuous activity.

4. High blood glucose levels— Individuals with type 1 diabetes should avoid exercise if fasting blood glucose is higher than 250 mg/dl and ketones are present. Caution should be used if glucose levels are higher than 300 and no ketones are present.  Individuals with type 2 diabetes should avoid exercise if blood glucose is higher than 400 mg/dl.  Monitoring blood glucose before, after and possibly during physical activity is necessary to keep blood glucose within an appropriate range.

Always consult with an exercise or health care professional before beginning any fitness program.

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Immune system:

Epidemiological evidence suggests that moderate exercise has a beneficial effect on the human immune system; an effect which is modelled in a J curve. Moderate exercise has been associated with a 29% decreased incidence of upper respiratory tract infections (URTI), but studies of marathon runners found that their prolonged high-intensity exercise was associated with an increased risk of infection occurrence. Regular moderate exercise is associated with a reduced incidence of infection compared with a completely sedentary state. However, prolonged bouts of strenuous exercise cause a temporary depression of various aspects of immune function (e.g., neutrophil respiratory burst, lymphocyte proliferation, monocyte antigen presentation) that usually lasts ∼3–24 h after exercise, depending on the intensity and duration of the exercise bout. Postexercise immune function dysfunction is most pronounced when the exercise is continuous, prolonged (>1.5 h), of moderate to high intensity (55–75% maximum O2 uptake), and performed without food intake. Periods of intensified training (overreaching) lasting 1 wk or more may result in longer lasting immune dysfunction. Although elite athletes are not clinically immune deficient, it is possible that the combined effects of small changes in several immune parameters may compromise resistance to common minor illnesses, such as upper respiratory tract infection. However, this may be a small price to pay as the anti-inflammatory effects of exercise mediated through cytokines and/or downregulation of toll-like receptor expression are likely mediators of many of the long-term health benefits of regular exercise.

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The figure above shows possible mechanisms by which exercise increases susceptibility to infection but reduces inflammation and risk of developing chronic disease. TLR, Toll-like receptor; TH1, T helper 1; IL-1ra, IL-1 receptor antagonist. The encircled minus sign represents an inhibitory action of IL-6 on TNF production.

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Inflammation:

Acute exercise induces a transient inflammatory response, including heightened CRP concentration. This is most likely due to joint and muscle inflammation after vigorous activity. However, regular, sustained exercise has been shown to suppress inflammation. This has been observed by studying inflammatory markers and physical activity patterns cross-sectionally and also by measuring CRP before and after periods of training. Among runners studied before and after 9 months of training in preparation for a marathon, mean CRP decreased by 31%. A strong and independent association between higher physical activity patterns and level of CRP was also observed in 3638 middle-aged or older healthy men. Those who engaged in physical activity ≥5 times per week had 37% lower CRP levels than those who performed activity roughly once a week or less. In a more generalized follow-up from the National Health and Nutrition Examination Survey III, CRP levels from 13748 adults were analyzed; the most active subjects had CRP levels nearly 50% lower than those of sedentary subjects. CRP levels have shown similar improvements in response to 3 months of cardiac rehabilitation.  Some reports suggest that CRP and other inflammatory markers are lower only among subjects who engage in relatively vigorous activities (jogging and aerobic classes) compared with those participating in less demanding activities.  However, others have reported markedly reduced CRP levels among those engaging in both larger and smaller volumes of physical activity compared with those who are sedentary. Biomarkers of inflammation such as C-reactive protein, which are associated with chronic diseases, are reduced in active individuals relative to sedentary individuals, and the positive effects of exercise may be due to its anti-inflammatory effects.

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It is widely recognized that atherosclerosis is largely an inflammatory process. The “response to injury” hypothesis as a cause of atherosclerosis suggests that damage to the arterial endothelium initiated by a pathogen leads to immune responses that interact with metabolic risk factors to propagate an arterial lesion, eventually progressing to an atherosclerotic plaque. Circulating immune cells are recruited to the inflamed vessel by interacting with adhesion molecules and other proteins associated with the body’s immune response. Inflammation particularly occurs in areas where plaque is unstable. It is thought that as many as 70% of myocardial infarctions occur in areas of “vulnerable plaque.” A number of blood markers have been identified that are associated with inflammation, most notably white blood cell count, C-reactive protein (CRP), homocysteine, fibrinogen, and other proteins involved in the immune response. The most widely studied inflammatory blood marker is CRP. In a recent follow-up study, elevated levels of CRP were associated with a higher risk of myocardial infarction, stroke, and mortality in both healthy individuals and patients with existing cardiovascular disease. The relationship between CRP and cardiovascular risk has consistently been shown to be independent of traditional risk factors such as smoking, hypertension, and lipid disorders. Others observed that CRP added markedly to the prognostic power of traditional risk factors and had twice the predictive value for cardiovascular events as low-density lipoprotein and HDL cholesterol. In the Physicians’ Health Study, the highest risk quartile for CRP was associated with a nearly 3-fold risk of sudden cardiac death compared with subjects in the lowest quartile for CRP. In addition, several recent studies have shown that higher CRP levels and other inflammatory markers are associated with risk factors that define the metabolic syndrome (abnormal blood glucose, obesity, low HDL cholesterol, high triglycerides, hypertension). In individuals with heart disease, exercise interventions lower blood levels of fibrinogen and C-reactive protein, an important cardiovascular risk marker. The depression in the immune system following acute bouts of exercise may be one of the mechanisms for this anti-inflammatory effect.

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Thrombosis:

Thrombosis plays a significant role in the pathogenesis of acute myocardial infarction, unstable angina, and sudden cardiac death, and therefore this issue has long been the topic of studies in the context of acute and chronic exercise. A number of hemostatic changes occur with exercise that involves blood platelets, coagulation factors, and fibrinolysis. Thrombin, a protein that has multiple catalyzing effects that promote clotting, activates platelets and other proteins in the “coagulation cascade,” leading to enhanced fibrin generation and clot formation. Both acute and chronic exercise regimens influence these markers of blood homeostasis. Because acute exercise is thought to increase platelet aggregation, concerns have been raised regarding exercise as a potential trigger for thrombosis-related cardiac events. However, such events are rare during exercise, and the precise role of the coagulation cascade in triggering cardiac events with acute exercise is unclear.  For example, acute exercise increases some clotting factors (particularly factor VIII and von Willebrand factor), and this has been associated with a reduction in clotting time, but it is unclear whether this leads to significant thrombin generation and/or fibrin formation.  Many of these changes disappear quickly during recovery from exercise, although other factors may take as long as 48 hours to return to baseline levels. There is considerable interindividual variability in the response to acute exercise, and these responses are dependent on exercise intensity, suppressed by β-blockade, enhanced by catecholamine responses, and more pronounced among patients with coronary artery disease. In contrast to acute exercise, both higher physical activity patterns and structured exercise programs have an inhibitory effect on thrombogenic factors and enhance blood fibrinolytic potential. These changes have been demonstrated in both healthy subjects and patients with cardiovascular disease and occur across a broad range of factors involved in the coagulation cascade. For example, platelet aggregation has been shown to be reduced after a low to moderate period of exercise training in overweight, hypertensive men and other high-risk groups. Although cross-sectional studies have consistently shown that plasma fibrinogen is lower among more active subjects,  controlled training studies on the effects of fibrinogen have been mixed. Nevertheless, the findings of most studies suggest that regular exercise has a significant impact on the coagulation cascade and may be a factor underlying the reduction in cardiovascular risk among physically active individuals.

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Osteoporosis, fractures and falls:

Exercise is very important for slowing the progression of osteoporosis, and extremely important for reducing the risk of falling, which causes fractures. Falls are one of the leading causes of death in people over the age of 65. Exercise helps build balance and flexibility, which reduces the risk of falling.

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Primary prevention:

Weight-bearing exercise, especially resistance exercise, appears to have the greatest effects on bone mineral density. In one review, several cross-sectional reports revealed that people who did resistance training had increased bone mineral density compared with those who did not do such training. Furthermore, athletes who engaged in high-impact sports tended to have increased bone mineral density compared with athletes who engaged in low-impact sports. Numerous longitudinal studies have examined the effects of exercise training on bone health in children, adolescents, and young, middle-aged and older adults. There is compelling evidence that routine physical activity, especially weight-bearing and impact exercise, prevents bone loss associated with aging. In a meta-analysis of RCTs, exercise training programs were found to prevent or reverse almost 1% of bone loss per year in the lumbar spine and femoral neck in both pre-and postmenopausal women. Exercise training appears to significantly reduce the risk and number of falls. The risk and incidence of fractures is also reduced among active people. Among 3262 healthy men (mean age 44 years) followed for 21 years, intense physical activity at baseline was associated with a reduced incidence of hip fracture (hazard ratio 0.38, 95% CI 0.16 to 0.91). This observation supports findings from an earlier investigation in which fracture rates were lower among people who performed more weight-bearing activities than among sedentary people. In summary, routine physical activity appears to be important in preventing loss of bone mineral density and osteoporosis, particularly in postmenopausal women. The benefits clearly outweigh the potential risks, particularly in older people.

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Secondary prevention:

Preliminary evidence from an RCT indicates that exercise training is effective in improving bone density in older women (75–85 years of age) with low bone mineral density. In this 6-month RCT, 98 women were randomly assigned to participate in resistance training (n = 32), agility training (n = 34) or stretching (sham exercise, n = 32). Agility training resulted in a significant increase in cortical bone density by 0.5% (standard error of the mean [SEM] 0.2%) at the tibial shaft, and resistance training resulted in a significant increase in cortical bone density by 1.4% (SEM 0.6%) at the radial shaft; the stretching group experienced losses in cortical bone density. Furthermore, a study involving early postmenopausal osteopenic women revealed that a 2-year intensive training program was effective in attenuating the rate of bone loss. In summary, preliminary evidence indicates that regular physical activity is an effective secondary preventive strategy for the maintenance of bone health and the fight against osteoporosis.

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Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: A systematic review and meta-analysis: 2015:

Seven randomized controlled trials involving 781 participants were included, 4 of which examined solely older people with cognitive impairment. Subgroup data on persons with cognitive impairment were obtained from the other 3 trials that targeted older populations in general. The meta-analysis showed that physical exercise had a significant effect in preventing falls in older adults with cognitive impairment, with a pooled estimate of rate ratio of 0.68 (95% confidence interval 0.51-0.91). The present analysis suggests that physical exercise has a positive effect on preventing falls in older adults with cognitive impairment. Further studies will be required to determine the modality and frequency of exercise that are optimal for the prevention of falls in this population.

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Asthma and chronic obstructive pulmonary disease (COPD):

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Effects of Exercise on Asthma

Exercise-Induced Asthma (EIA):

Exercise-induced asthma occurs when exercise triggers coughing, wheezing, or shortness of breath. It occurs most often in children and young adults and during intense exercise in cold dry air. EIA is triggered only by exercise. Unlike allergic asthma, there is no long-term increase in airway activity. People who have only EIA do not need long-term maintenance therapy. The warm-up and cool-down periods, which are important for any exercise regimen, may help reduce EIA events. EIA is not a reason to exclude people from physically demanding occupations. The preferred term for this condition is exercise-induced bronchoconstriction (EIB); exercise does not cause asthma, but is frequently an asthma trigger. If you have EIB, you may have problems breathing within five to 20 minutes after exercise. Symptoms of EIB are similar to those of chronic asthma, but the timing of the symptoms is closely linked with physical activity. People with EIB are typically very sensitive to both low temperatures and dry air. Air is usually warmed and humidified by the nose, but during demanding activity people breathe more through their mouths. This allows cold, dry air to reach your lower airways and your lungs without passing through your nose, triggering asthma symptoms. Air pollutants, high pollen levels and viral respiratory infections may also be triggers. Other causes of symptoms while exercising include being out of shape, poorly controlled nasal allergies or vocal cord issues.

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Exercise is a common trigger of asthma, particularly in children. The mechanism is linked to hyperventilation, which results in increased osmolality in airway lining fluid and triggers mast cell mediator release, resulting in bronchoconstriction. Exercise-induced asthma (EIA) typically begins after exercise has ended, and recovers spontaneously within about 30 minutes. EIA is worse in cold, dry climates than in hot, humid conditions. It is, therefore, more common in sports such as cross-country running in cold weather, overland skiing, and ice hockey than in swimming. It may be prevented by prior administration of beta 2-agonists and antileukotrienes, but is best prevented by regular treatment with inhaled corticosteroids, which reduce the population of surface mast cells required for this response.

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The following are some suggestions for reducing the impact of EIA:

•For those with chronic asthma, follow the health care provider’s instructions for using long-term control medications, particularly inhaled corticosteroids, when prescribed.

•Warm-up and cool-down periods are important.

•Patients with EIA might do better with activities that involve short bursts of exercise (tennis, football), rather than with exercises involving long-duration regular pacing (cycling, soccer, and distance running). In winter, indoor exercise is best. Swimming is particularly desirable because of the humidity.

•When exercising in cold air, breathing through a scarf or through the nose helps warm up the airways.

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Managing EIA/EIB:

People with EIB are still able to exercise – and should exercise regularly. But you need to be sure that you are doing the right kind and right amount of exercise. To prevent asthma flare-ups, your doctor may prescribe that you take an inhaled short-acting medication prior to exercise. These medications are effective in preventing EIB symptoms in 80 to 90% of patients. Drinking water, warming up and cooling down as part of your exercise routine can also help minimize EIB

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Is it good for people with asthma to exercise?

Yes. Even though physical exercise is a common trigger of asthma symptoms, it is just as important for people with asthma to exercise as for anyone else. Keep in mind that it takes time to get in shape and you lose fitness quickly when you stop exercising regularly. With the right medication, most people with asthma will be able to do some kind of physical exercise, many will feel no restrictions, and some will only react to exercise in combination with other triggers.

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How can I avoid exercise-induced asthma?

The best way to avoid exercise-induced asthma is to make sure that your asthma is properly controlled and, if necessary, that you take extra medication before exercising. A good warm-up also reduces the risk of exercise-induced asthma. Anti-inflammatory treatment, preferably with inhaled corticosteroids, taken regularly will prevent exercise-induced asthma in many people. However, some people still need to take an airway opener (bronchodilator) before exercise. Many people with asthma should have daily treatment with both inhaled corticosteroids and a long acting bronchodilator. Combination medications are now available in many countries. Particular types of exercise, such as running and jogging, are more likely to expose the airways to large volumes of dry air and trigger asthma, while less vigorous activities, like swimming and yoga, are less likely to cause these symptoms.

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What types of Exercise are best for people with Asthma?

Activities that involve short, intermittent periods of exertion, such as volleyball, gymnastics, baseball, and wrestling, are generally well tolerated by people with symptoms of asthma. Activities that involve long periods of exertion, such as soccer, distance running, basketball, and field hockey, may be less well tolerated. Also, cold-weather sports, such as ice hockey, cross-country skiing, and ice-skating, may pose challenges. However, many people with asthma are able to participate fully in these activities. Swimming, which is a strong endurance sport, is generally well tolerated by many people with asthma because it is usually performed while breathing warm, moist air. It is also an excellent activity for maintaining physical fitness. Other beneficial activities for people with asthma include both outdoor and indoor biking, aerobics, walking, and running on a treadmill.

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Study finds that Daily Exercise relieves Asthma symptoms: 2015:

Physical activity has been shown to offer various health benefits for patients with asthma, especially in children. However, there is still limited data on the nature of the association between physical activity and asthma control in adults. Results from a recent study published in the BMJ Open Respiratory Research, a team of researchers found that asthma patients who engaged in optimal levels of physical activity on a regular basis were nearly two-and-a-half times more likely to have good control of their symptoms compared to those who didn’t exercise. Just 30 minutes a day of walking, riding a bike, doing yoga — anything active, really — can result in significant reduction of asthma symptoms. Patients with asthma have been discouraged from engaging in physical exercise as it is thought to trigger shortness of breath and asthma attacks. However, simple protective measures can be taken to prevent the discomforts that physical activity can cause. The issue of exercise-induced bronchospasm is real — but if you use your reliever medication before you exercise, and then take the time to cool down afterwards, you should be okay.

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Effects of Exercise on COPD:

Walking is the best exercise for people with emphysema. Patients should try to walk three to four times daily for 5 – 15 minutes each time. Devices that assist ventilation may reduce breathlessness that occurs during exercise. Exercising and strengthening the muscles in the arms and legs helps some patients improve their endurance and reduce breathlessness Inspiratory muscle training involves exercises and devices that make inhaling (breathing in) more difficult, in order to strengthen breathing muscles. Yoga or martial arts exercises, such as tai chi, which emphasize breathing techniques and balanced movements, may be particularly beneficial for patients with emphysema. A study found that for COPD, incremental aerobic resistance physical exercises are better than constant load physical exercises at an intensity range from 90% to 50 % of VO2 max, with a frequency of two or four days a week, the session is from 30 to 60 minutes during a period of treatment from eight to twelve weeks. Exercise training induces several symptomatic and functional adaptations resulting in an increased aerobic capacity.

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Exercise and testosterone:

If you’re a man with low testosterone, exercise may help.  Doctors and fitness professionals still have a lot to learn about exercise and its effects on testosterone. Several factors besides your workout are involved. But one thing is clear: You need to make exercise a habit in order to get the benefits. After exercise, testosterone levels rise — but not for long. It’s not yet clear what health effects, if any, these temporary boosts may have. Of course, exercise has many other well-known health perks. For men who have low testosterone, exercise alone probably won’t raise their levels enough to make a difference in how they feel but for men whose testosterone level is on the borderline between normal and low, it’s going to have a much more potent effect.

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Exercise improves sex life:

Studies show exercise leads to a higher quality sex life. It soups up your sex life. Sex and exercise go hand-in-hand. In a study of women between 45 and 55 years old, those who exercised, including brisk walking, reported not only greater sexual desire, but better sexual satisfaction, too. You are also likely to feel more fit and be more fit, which in turn will benefit your interest in and ability to carry out sexual activity. Your emotional resilience will also be greater if you exercise, which also benefits your relationship health. Regular exercise boosts circulation, and primes the brain for sexual satisfaction. It gets your blood flow pumping, which not only creates rosy cheeks, but also improves arousal. Physical fitness can increase blood flow, which in theory can make sex more pleasurable since sexual arousal for both men and women involves increased blood flow to the genital area. Lubrication, genital sensation, and the tingle of sexual excitement are all fuelled by good blood flow. In order to have an erection, the penis must swell with blood. Blocked arteries, high blood pressure and other cardiovascular issues can interfere with that process. Exercise keeps the heart and arteries healthy, reducing the risk of erectile dysfunction. Researchers looked at men over the age of 50 and found that those who were physically active reported better erections and a 30% lower risk of impotence than men who were inactive.  During exercise, endorphins bathe the brain, washing away tension and ushering in positive, empowering thoughts. In addition, exercise increases testosterone (essential for libido), by adding muscle mass, and this can take your libido to new heights and mentally (as well as the physical) improve our body image, making us more confident in the bedroom. Exercise strengthens pelvic floor muscles so that both men and women get better and intense orgasm. Not only can exercise improve your sex life, but sex can actually double as exercise. An energetic session can scorch calories and give you a full-body workout, especially if you incorporate plenty of positions and foreplay. Sex itself is a physical activity and burns calories and increases fitness. Many factors influence how many calories are spent during sex, but most reports seem to indicate about 85 for a half hour to hour session. Besides sex can also increase self-esteem, cardio-vascular health, emotional intimacy, improves sleeping, and increase immunity!

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Exercise and obesity:

Obesity and overweight are considered to be leading risk factors for a number of chronic health conditions, including diabetes mellitus, hypertension, CHD, and premature mortality. Obesity not only increases CHD risk directly but also enhances it indirectly through its adverse effects on several established risk factors, including insulin resistance and hypertension. Although the causes of obesity are complex, physical inactivity is considered to be an important causal factor. For example, in a representative sample of American adults, the relative risk of obesity among individuals physically active in leisure time (≥5 bouts of physical activity per week) was ≈50% lower than among those who were physically inactive. Although such an association does not demonstrate cause and effect, this and similar reports strongly suggest that a relationship exists between physical activity levels and obesity, in which comparatively sedentary individuals are more likely to be obese compared with those who are physically active.

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Despite relatively modest weight reductions associated with structured programs of physical activity, findings from large epidemiological studies support the concept that a reduced risk of cardiovascular disease and all-cause mortality occurs among more active individuals regardless of weight loss. In a large follow-up from the ACLS (n=25 714), higher fitness levels were associated with lower risk of mortality in normal-weight, overweight, and obese men. Compared with other risk factors (total cholesterol, hypertension, and smoking), having a low fitness level carried similarly heightened risks in each weight category for both cardiovascular and all-cause mortality. In a subsequent study from the ACLS among older subjects (>60 years), higher waist circumference was associated with higher mortality, but this association was not significant after adjustment for fitness.  Fitness strongly predicted mortality independent of measures of body dimensions. These investigators suggested that it is as important for clinicians to assess the fitness status of an overweight or obese patient as it is to evaluate BP, inquire about smoking habits, and measure fasting plasma glucose and lipid levels. As mentioned above, modest weight reductions have been associated with structured programs of physical activity. Because of the high prevalence of overweight and obesity among patients referred for cardiac rehabilitation (estimated to be >80%), there has been recent interest in high-calorie-expenditure exercise. A recent trial demonstrated that patients randomized to an intensive counselling and exercise program designed to achieve an energy expenditure of 3000 to 3500 kcal/wk experienced double the weight loss of those in the standard cardiac rehabilitation group (8.2±4 versus 3.7±5 kg), a greater reduction in waist circumference, reduced insulin resistance, improved blood lipids, and lower prevalence of the metabolic syndrome (59% versus 31%).

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The following are some suggestions and observations on exercise and weight loss:

•The treadmill burns the most calories of standard aerobic machines. Exercise sessions as short as 10 minutes, which are done frequently (about four times a day), may be the most successful program for obese people.

•The more strenuous the exercise, the longer the body continues to burn calories before returning to its resting level. This state of fast calorie burning can last for as little as a few minutes after light exercise, to as long as several hours after prolonged or heavy exercise.

•Resistance (strength) training is excellent for reducing fat and building muscles. It should be performed two or three times a week.

•Fidgeting may be very helpful in keeping pounds off. Regular exercise is certainly the best course, but for people who must sit for hours at work, frequently shifting positions while sitting may have some benefit.

•It is important to realize that as people slim down, they burn fewer calories per mile of walking or jogging. The rate of weight loss slows down, sometimes discouragingly so, after an initial dramatic head start using diet and exercise combinations. People should be aware of this trend and keep adding to their daily exercise routine.

•Changes in fat and muscle distribution may differ between men and women as they exercise. Men tend to lose abdominal fat (which lowers their risk for heart disease faster than reducing general body fat). In women, aerobic and strength training are more likely to result in fat loss in the arms and trunk. However, they do not gain muscle tissue in those areas.

Because obesity is one of the risk factors for heart disease, anyone who is overweight must discuss their exercise program with a physician before starting.

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How much am I burning?

This chart shows the estimated number of calories burned while doing various exercises for one hour. Specific calorie expenditures vary widely depending on the exercise, intensity level and individual characteristics such as weight.

Activity (1-hour duration) Weight of person and calories burned
160 pounds (73 kilograms) 200 pounds (91 kilograms) 240 pounds (109 kilograms)
Aerobics, high impact 533 664 796
Aerobics, low impact 365 455 545
Aerobics, water 402 501 600
Backpacking 511 637 763
Basketball game 584 728 872
Bicycling, < 10 mph, leisure 292 364 436
Bowling 219 273 327
Canoeing 256 319 382
Dancing, ballroom 219 273 327
Elliptical trainer, moderate effort 365 455 545
Football, touch or flag 584 728 872
Golfing, carrying clubs 314 391 469
Hiking 438 546 654
Ice skating 511 637 763
Racquetball 511 637 763
Resistance (weight) training 365 455 545
Rollerblading 548 683 818
Rope jumping 861 1,074 1,286
Rowing, stationary 438 546 654
Running, 5 mph 606 755 905
Running, 8 mph 861 1,074 1,286
Skiing, cross-country 496 619 741
Skiing, downhill 314 391 469
Skiing, water 438 546 654
Softball or baseball 365 455 545
Stair treadmill 657 819 981
Swimming laps, light or moderate 423 528 632
Swimming laps, vigorous 715 892 1,068
Tae kwon do 752 937 1,123
Tai chi 219 273 327
Tennis, singles 584 728 872
Volleyball 292 364 436
Walking, 2 mph 204 255 305
Walking, 3.5 mph 314 391 469
Yoga, hatha 183 228 273
Yoga, power 292 364 436

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Although vigorous exercise is good for weight loss, moderate aerobic exercise burning 3500 Kcal per week confers survival benefit:

One recent study found that in overweight sedentary subjects, moderate exercise was more efficient at helping them burn body fat – including a reduction that was far greater than what could be explained by the caloric expenditure – while intense exercise induced a “compensatory” response that hampered fat loss. Another study examined weekly caloric expenditure via aerobic exercise in a group of former athletes and non-athletes and plotted it against mortality, cardiovascular disease, and hypertension. Those who exercised moderately lived the longest and were healthiest. In a study on the exercise habits of college alumni and their impact on mortality, researchers found that up to 3,500 calories expended per week conferred a survival benefit, but at calorie expenditures greater than that, mortality began to tick upwards. And in a pair of recent studies, researchers found that moderate exercise – jogging up to 20 miles a week at an 11 minute mile pace – offered the most protection against early mortality. Running more than 20 miles a week, or running at a 7 minute mile pace, offered fewer mortality benefits. In the second paper, Danish scientists found that people who spent one to two and a half hours jogging at a “slow or average pace” lived longer than those who didn’t run at all or who ran at a faster pace. James O’Keefe, a cardiologist and presenter at the Ancestral Health Symposium, was quoted as saying that “after about 45 to 60 minutes a day, you reach a point of diminishing returns.” It’s pretty clear that once exercise gets to be “too much,” the benefits are reduced, or even reversed, and it becomes a chronic stressor that reduces overall wellness.

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What’s better for Weight Loss: Diet or Exercise?

A new study in the International Journal of Epidemiology shows that it might be more about what you eat, putting truth to the idiom “abs are made in the kitchen, not the gym.” In 2013, researchers from Loyola University began looking into the relative power of diet and exercise as they relate to moving the scale. They thought they’d discover that exercise would prove to be a crucial component for weight loss. Two years later, though, the science shows that the largest driver behind obesity is not how sedentary people are but instead how poor their diet is. Physical activity is crucially important for improving overall health and fitness levels, but there is limited evidence to suggest that it can blunt the surge in obesity. Why? The more you work out, the more your appetite increases. Of course, this new Loyola study isn’t the first to come to this conclusion. Research has consistently shown for years now that exercise doesn’t necessarily lead to weight loss. In a meta-analysis published in the Journal of the Academy of Nutrition and Dietetics last year, for example, researchers found that people only lost noticeable weight if they combined exercise and calorie restriction. Plus, research shows that dieters who exercise are better able to maintain weight loss and are also able to lose fat while keeping valuable muscle. You just need to make sure you’re logging your gym time and your food intake. Researchers challenge conventional wisdom further by arguing that those who want to avoid excess weight gain should adopt a diet that is high in fat but low on both sugar and carbohydrates.  Athletes and others about to do exercise should ditch high-carbohydrate intake regimes and instead eat more fat, they say, because “fat, including ketone bodies, appears to be the ideal fuel for most exercise. It is abundant, does not need replacement or supplementation during exercise, and can fuel the forms of exercise in which most participate.”  Catherine Collins, of the British Dietetic Association, said the doctors had downplayed the metabolic and physical health benefits of undertaking even moderately intense exercise and had used “incomplete evidence” to make their case.  Professor Susan Jebb, professor of diet and population health at Oxford University, who also chairs the food network of the government’s Responsibility Deal, said: “The authors fail to note that weight loss programmes which combine diet and physical activity are the most successful route to weight loss in both the short (three to six months) and medium term (12 months)”.

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Belly fat:

The myth of targeted fat reduction:

Spot reduction is a myth that exercise and training a particular body part will preferentially shed the fat on that part; for example, that doing sit-ups is the most direct way to reduce subcutaneous belly fat. This is false: one cannot reduce fat from one area of the body to the exclusion of others. Most of the energy derived from fat gets to the muscle through the bloodstream and reduces stored fat in the entire body, from the last place where fat was deposited. Sit-ups may improve the size and shape of abdominal muscles but will not specifically target belly fat for loss. Such exercise might help reduce overall body fat and shrink the size of fat cells. There is a very slight increase in the fat burnt at the area being exercised (e.g. abs) compared with the rest of the body, due to the extra blood flow at this area.

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Reduce belly fat:

An extra storage of fat in the belly could bring about different health conditions. There are two kinds of belly fat: visceral and subcutaneous. If the amount of fat in the belly area is large, there is greater risk of developing joint problems, sleep apnea, colorectal cancer, high blood pressure, diabetes, breast cancer, and heart disease. If you’re looking to shrink and tone your belly, there’s a better way to do it than trying to do crunches. In fact, research has shown that doing abdominal exercises alone—even when performed five days a week for six weeks—has no effect at all on subcutaneous fat stores and abdominal circumference. Jennifer Cohen suggests using strategies that burn up cortisol instead. Cortisol is a hormone in your body that depletes lean muscle and holds on to fat in the abdominal region.  One of the most important ways to help this process is to reduce stress in your life, because stress causes cortisol levels to spike. Cohen also delves into a number of other strategies that help reduce your cortisol levels, such as the following.

1. Getting enough sleep

2. Reducing or eliminating refined sugars from your diet

3. Slowing down your breathing

4. Doing short bursts of exercise (high-intensity interval training)

5. Supplementing with vitamin C

6. Eating fats―the good kinds such as the omega 3′s found in salmon, avocados and walnuts

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Once you’ve addressed your diet, exercise can truly begin to work its magic on your physique, and help boost fat loss even further. The trick to achieve flat abs is to incorporate the correct types of exercises.  High-intensity interval exercises are at the core. This short intense training protocol improves muscle energy utilization and expenditure due to its positive effects on increasing muscle mass and improving muscle fiber quality. Muscle tissue burns three to five times more energy than fat tissues, so as you gain muscle, your metabolic rate increases, which allows you to burn more calories, even when you’re sleeping. Further, several studies have confirmed that exercising in shorter bursts with rest periods in between burns more fat than exercising continuously for an entire session. In fact, you can actually lose more weight by reducing the amount of time you spend on exercise, because when doing high-intensity interval training you only need 20 minutes, two to three times a week.

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Exercises that target your Abs:

While ab workouts specifically may not help you reduce body fat, they still provide important benefits and should not be overlooked. Your abdominals are part of your body’s 29 core muscles, which are located mostly in your back, abdomen and pelvis. This group of muscles provides the foundation for movement throughout your entire body, and strengthening them can help protect and support your back, make your spine and body less prone to injury and help you gain greater balance and stability. When you build your ab muscles, it’s like developing an internal corset that holds your gut in. By doing so, you help stabilize your spine, vertebrae and discs, which in turn can significantly reduce back pain and make it easier for you to lift heavy items, twist and turn and perform the movements required for a full life. Having a strong abdominal wall is very important for optimal body movement and gets increasingly more important with advancing age. A strong abdominal wall is also what will produce that six-pack look once you’ve lost sufficient amounts of subcutaneous fat. However, conventional crunches and sit-ups are not the most effective when it comes to creating flat, well-defined abs. In order to effectively train your core muscles, you must incorporate a variety of stabilization, functional and traditional exercises. A study by Petrofsky (2007) actually put this to the test by researching how much muscle activity is generated by different abdominal exercises. The simple, traditional abdominal floor crunch was found to produce and recruit the least amount of muscle activity when subjects were attached to an electromyography (EMG) machine! That’s not to say that you should never perform a traditional abdominal crunch; but this particular exercise should be done as part of a varied core-strengthening routine. This may include:

•Traditional exercises, such as a standard crunch with rotation or a standing rotation with a light hand weight.

•Functional exercises, including work on a stability ball.

•Stabilizing exercises, such as lying on the floor and pulling your belly back toward your spine and holding that position while breathing deeply

•Extension exercises, such as lying on your stomach with arms extended above your head. Then raising both arms and both legs, at the same time, off the floor. (Hold for a count of 5, or 5 breaths, and slowly return to the floor.)

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How to reduce stomach size after delivery?

Reducing the tummy after delivery can be quite difficult as the stomach of a woman continues to bulge even after child birth. Carrying the weight of the child causes a stretching of the stomach, and it does not go back automatically to the original shape. Some of the tips to reduce fat after delivery include performing some mild exercises after enough rest has been taken post-delivery. A simple routine of walking for around 20 minutes each day can be helpful. It is also essential that you choose the right foods as part of your diet for belly fat reduction. You should include wheat bread, nuts, lean meats, fresh fruits, and leafy vegetables to your meals. It is also important that your diet is healthy as the baby will feed on what you eat.  Physical exercise is the best way to reduce tummy after a C-section. However, you should avoid any exercise that is too vigorous as physical stress can have an impact in the natural recovery process. After consulting a doctor, you can also perform some aerobic exercises to decrease stomach fat. These exercises include dancing, swimming, and cycling. However, it is important that you first consult a doctor before performing these exercises. You could also try some crunches and Pilates.

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Exercise and brain:

Introduction:

The relationship between exercise and your brain is the most important one for increasing brain power. When we’re young, we lose approximately 2% of our brain volume as brain cells die. Once we reach age 60, brain cell loss accelerates to 2% loss every two years. And for people with Alzheimer’s, cell loss is double that. Unfortunately, it is the hippocampus, the seat of our memory, which loses the most cells. Exercise has been shown to reverse this process of brain atrophy in the hippocampus. One studied showed this could be accomplished simply by walking regularly. Exercise encourages the growth of new brain cells just like it makes our muscles grow. Some neuroscientists believe that exercise might do more to improve your brain than thinking does. Exercise increases circulation which increases the supply of oxygen and glucose to your brain. This particularly benefits the hippocampus and thus improves memory, concentration, and focus. It also benefits the prefrontal cortex where planning and reasoning occur. By improving circulation, you are also reducing your chances of dementia that is caused by heart disease. Exercise also improves blood sugar control which lowers the risk for diabetes. There is a correlation between diabetes and the risk of Alzheimer’s. Exercise increases endorphin release which in turn makes you feel happier and more relaxed, while reducing your risk of developing problems with anxiety or depression. Surprisingly, it’s been found that those who regularly exercise moderately have better cognitive functions than people who regularly exercise strenuously! Strenuous exercise draws glucose and oxygen away from your brain and into your muscles. Vigorous exercise also increases free radical production. Because your brain uses a lot of oxygen, it is very susceptible to free radical damage.

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There are several possibilities for why exercise is beneficial for the brain.

•increasing the blood and oxygen flow to the brain;

•increasing growth factors that help neurogenesis and promote synaptic plasticity — possibly improving short and long term memory;

•increasing chemicals in the brain that help cognition, such as dopamine, glutamate, norepinephrine, and serotonin.

Physical activity is thought to have other beneficial effects related to cognition as it increases levels of nerve growth factors, which support the survival and growth of a number of neuronal cells.

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Neurobiology of exercise:

The neurobiological effects of physical exercise are numerous and involve a wide range of interrelated neuropsychological changes. A large body of research in humans has demonstrated that consistent aerobic exercise (e.g., 30 minutes every day) induces persistent beneficial behavioral and neural plasticity as well as healthy alterations in gene expression in the brain; some of these long-term effects include: increased neuron growth, increased neurological activity (c-Fos and BDNF signalling), improved stress coping, enhanced cognitive control over behavior, improved declarative and working memory, and structural and functional improvements in brain structures and pathways associated with cognitive control and memory. The effects of exercise on cognition have important implications for improving academic performance in children and college students, improving adult productivity, preserving cognitive function in old age, preventing or treating certain neurological disorders, and improving overall quality of life.

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Neuroplasticity and neurogenesis:

Neuroplasticity is essentially the ability of neurons in the brain to adapt over time, and most often occurs in response to repeated exposure to stimuli; whereas neurogenesis is the postnatal (after-birth) growth of new neurons, a beneficial form of neuroplasticity.  Aerobic exercise promotes neurogenesis by increasing the production of neurotrophic factors (compounds which promote the growth or survival of neurons), such as brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1 (IGF-1), and vascular endothelial growth factor (VEGF). Consistent aerobic exercise over a period of several months induces marked clinically significant improvements in executive function (i.e., the “cognitive control” of behavior) and increased gray matter volume in multiple brain regions, particularly those which give rise to cognitive control. The brain structures that show the greatest improvements in gray matter volume in response to aerobic exercise are the prefrontal cortex and hippocampus; moderate improvements seen in the anterior cingulate cortex, parietal cortex, cerebellum, caudate nucleus, and nucleus accumbens.  The prefrontal cortex, caudate nucleus, and anterior cingulate cortex are among the most significant brain structures in the dopamine and norepinephrine systems that give rise to cognitive control.  Exercise-induced neurogenesis (i.e., the increases in gray matter volume) in the hippocampus is associated with measurable improvements in spatial memory.  Higher physical fitness scores (measured by VO2 max) are associated with better executive function, faster processing speed, and greater volume of the hippocampus, caudate nucleus, and nucleus accumbens. Long-term aerobic exercise is also associated with persistent beneficial epigenetic changes that result in improved stress coping, improved cognitive function, and increased neuronal activity (c-Fos and BDNF signalling).

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If you start exercising, your brain recognizes this as a moment of stress. As your heart pressure increases, the brain thinks you are either fighting the enemy or fleeing from it. To protect yourself and your brain from stress, you release a protein called BDNF (Brain-Derived Neurotrophic Factor). This BDNF has a protective and also reparative element to your memory neurons and acts as a reset switch. That’s why we often feel so at ease and like things are clear after exercising. Simultaneously, your brain releases endorphins, another stress-related chemical. The endorphins minimize the physical pain and discomfort associated with exercise. They’re also responsible for the feeling of euphoria that many people report when exercising regularly. The researchers also discovered that exercise does not affect the brains of all people in exactly the same way. Some people, about 30 percent of people of European Caucasian descent, have a BDNF gene variant that hinders post-exercise BDNF production. The people with this BDNF variant did not improve their memory scores, even when exercising regularly, as significantly as those without this variant. Still, the research clearly suggests that—with individual variations as to the degree—regular exercise will cumulatively enhance your memory and other brain functions.

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Regular exercise has been shown to counter the shrinking of the hippocampus and memory impairment that naturally occurs in late adulthood. Sedentary adults over age 55 show a 1–2% decline in hippocampal volume annually. A neuroimaging study with a sample of 120 adults revealed that participating in regular aerobic exercise increased the volume of the left hippocampus by 2.12% and the right hippocampus by 1.97% over a one-year period.  Subjects in the low intensity stretching group who had higher fitness levels at baseline showed less hippocampal volume loss, providing evidence for exercise being protective against age-related cognitive decline. In general, individuals that exercise more over a given period have greater hippocampal volumes and better memory function.

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Epigenetic effects of exercise on brain:

Figure above shows proposed model for the effect of exercise on molecular, neuroplastic and cognitive patterns through epigenetics. IGF-1: Insulinlike growth factor-1; VEGF: Vascular endothelial growth factor; BDNF: Brain-derived neurotrophic factor.

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Exercise, cognition and dementia:

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How exercise improves cognition:

Figure above provides a schematic illustration of some of the important factors which both help to influence whether (and the extent to which) individuals participate in cardiovascular fitness training as well as the potential mechanisms of improved fitness and the influence of these mechanisms on cognition. The factors included in the illustration are derived from animal research, human epidemiological studies, and human randomized clinical trials.

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Physical activity has been shown to be neuroprotective in many neurodegenerative and neuromuscular diseases. Evidence suggests that it reduces the risk of developing dementia. The Caerphilly Heart Disease Study followed 2,375 male subjects over 30 years and examined the association between regular physical exercise and dementia. The study found that men who exercised regularly had a 59% reduction in dementia when compared to the men who didn’t exercise.  In addition, a 2008 review of cognitive enrichment therapies (strategies to slow or reverse cognitive decline) concluded that “physical activity, and aerobic exercise in particular, enhances older adults’ cognitive function”. In mice, exercise improves cognitive functioning via improvement of spatial learning, and enhancement of synaptic plasticity and neurogenesis. In a 2009 study, scientists made two groups of mice swim a water maze, and then in a separate trial subjected them to an unpleasant stimulus to see how quickly they would learn to move away from it. Then, over the next four weeks they allowed one group of mice to run inside their rodent wheels, an activity most mice enjoy, while they forced the other group to work harder on mini-treadmills at a speed and duration controlled by the scientists. They then tested both groups again to track their learning skills and memory. Both groups of mice improved their performances in the water maze from the earlier trial. But only the extra-worked treadmill runners were better in the avoidance task, a skill that, according to neuroscientists, demands a more complicated cognitive response. The mice who were forced to run on the treadmills showed evidence of molecular changes in several portions of their brains when viewed under a microscope, while the voluntary wheel-runners had changes in only one area. According to an author of the study, “our results support the notion that different forms of exercise induce neuroplasticity changes in different brain regions.” Furthermore, anecdotal evidence suggests that frequent exercise may reverse alcohol-induced brain damage. There is also some evidence that physical activity may help to slow the progression of Alzheimer’s and reduce its risk through a number of mechanisms such as promoting vascular health by lowering blood pressure and reducing other risk factors that lead to the disease.  Research so far in this area is showing promising results – but further studies need to be done. Epidemiological studies suggest that exercise reduces the risk of Parkinson’s disease, and regular physical activity is shown to improve the quality of life in Parkinson’s disease patients and reduce their neurological symptoms. However, there is limited evidence on the exact cognitive processes and, again, further studies need to be done.

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Walking slows cognitive decline: 2010 study:

Walking may slow cognitive decline in adults with mild cognitive impairment (MCI) and Alzheimer’s disease, as well as in healthy adults, according to a study presented today at the annual meeting of the Radiological Society of North America.

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Figure above compares the beneficial effects of physical activity on the brains of healthy aging individuals (n = 299) to the positive relationships between exercise and brain structure in cognitively impaired persons with either mild cognitive impairment or Alzheimer’s (n = 127). In both normal aging and cognitive impairment, physical activity preserves volume in brain areas that are important for memory, learning, and attention. These structures include the prefrontal cortex and temporal cortex. The top row of images shows these relationships in a 3-D rendering of the brain while the bottom row shows the prefrontal cortex findings in side view cutaway images of the brain..

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Exercise makes you smarter:

University of South Carolina experts found regular treadmill sessions create more mitochondria – structures in the cells that produce the body’s energy – in the brain. This energy boost helped the brain to work faster and more efficiently, effectively keeping it younger, researchers said. In the short term this could reduce mental fatigue and sharpen your thinking in between gym sessions. And building up a large reservoir of mitochondria in the brain could also create a ‘buffer’ against age-related brain diseases such as Alzheimer’s.

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Exercise improves balance and coordination: 2015 study on twins:

Physical activity can increase grey matter in the brain, increasing the size of areas that contribute to balance and coordination. The changes in the brain may have health implications in the long-term, such as reducing the risk of falling. It could also reduce the risk of being immobile in older age. Authors recruited 10 pairs of identical twins, who were all men aged 32 to 36 years. Focusing on twins, who have the same DNA, would allow researchers to see how their environment affects their bodies. In each pair of twins, one brother had exercised more over the past three years than the other, though they reported they carried out similar levels of exercise earlier in their lives. The twins had MRI scans of their brains so researchers could see whether physical activity had any impact on the size of their brains, and specific regions. Exercise didn’t seem to affect the size of the brain as a whole. But there was a connection between more activity and more brain volume in areas related to movement. The twins who exercised more did a better job of controlling their blood sugar, which reduces the risk of diabetes, a finding which is already well-known. The study was published in the journal Medicine & Science in Sports & Exercise.

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Physical exercise can keep your brain young: 2015:

In an investigation of more established men between ages 64-75 years, the specialists found that the fitter men performed preferable rationally over the less fit men, by utilizing parts of their brains as a part of the same route as in their childhood. In other words, fit older people are more likely to use their brains the way they did when they were young, compared to older people seeing a decline in this area. This change is known as HAROLD (hemispheric asymmetry reduction in older adults), and reflects adaptations of the brain necessary to make up for reduced brain capacity and efficiency caused by age-related structural and physiological decline. When we’re young, we use the left side of the brain more than the right and older adults tend to have both sides of their PFC active without having a difference between right and left regions.

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The bottom line is more exercise on a daily basis may very well lead to a younger better performing brain. The secret to a younger brain may be in exercising your body. There has been evidence which supports the theory that adults who are fitter are able to better maintain this white matter than adults who are not as fit.

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The effects of exercise on cognitive function in children and young adults:

Unfortunately, there have been far fewer studies involving young people. However, one study, reported at the 2001 Society for Neuroscience conference, found that following a 12 week regimen of jogging for 30 minutes two to three times a week, young adults significantly improved their performance on a number of cognitive tests. The scores fell again if participants stopped their running routine. The researchers suggested that increased oxygen flow to the brain might have been behind the improvement in mental sharpness. Oxygen intake did rise with the joggers’ test scores. Supplemental oxygen administration has been found to significantly improve memory formation in healthy young adults, as well as improving reaction time. A new analysis of 19 studies involving 586 kids, teens, and young adults that was published in the British Medical Journal found that short 10 to 40 minutes bursts of exercise led to an immediate boost in concentration and mental focus, likely by improving blood flow to the brain. These results provide further evidence that doing about 20 minutes of exercise just before taking a test or giving a speech can improve performance. Public health experts have long complained about the cutting of gym and recess time at school to make time for more academics, which could actually be having the opposite effect of impeding kids’ learning.  Preliminary results from a series of studies undertaken with elementary school children do indicate a strong relationship between academic achievement and fitness scores. One study found that physically fit children identified visual stimuli faster. Brain activation patterns provided evidence that the fit children allocated more cognitive resources towards the task, as well as processing information faster.

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Physical activity and academic performance in school-age children:

Recently, owing to the increasing importance placed on standardized testing, many schools in the United States have reduced or eliminated physical education (PE) requirements, in an effort to increase students’ academic performance. However, no empirical evidence exists to suggest that the elimination of non-academic programmes (such as PE) is related to higher academic achievement. In fact, empirical evidence suggests otherwise. Aerobic fitness has a small but positive relation to academic achievement, whereas body mass index (BMI) has a negative relation. Recent studies have indicated that achievement in standardized tests of mathematics and reading was positively related to physical fitness scores, measured using the progressive aerobic cardiovascular endurance run (PACER) test (a 20 metre shuttle run that increases in difficulty and is considered a field test of aerobic capacity), in school-age children. This relationship was selective to aerobic fitness, as muscle strength and flexibility fitness were unrelated to academic achievement. Similarly, beneficial relationships have been observed between physical activity and other measures of academic performance, such as academic grades in the classroom. Relevant neural networks have been identified for component processes that might be involved in mathematics and reading performance. Research that examined the functional neuroanatomy of reading comprehension revealed an activation of the prefrontal cortex (PFC) and parietal/posterior cingulate cortex (PCC). Likewise, mathematical calculations and numerical magnitude processing have been linked to bilateral regions of the intraparietal sulcus in children and adults. However, children also recruit the right dorsolateral prefrontal cortex. Given that both mathematics and reading elicit activation in the frontoparietal network, there is a sound basis for examining these structures in relation to academic performance. As fitness has also been related to the frontoparietal network, it would follow that children might derive benefits in school performance from increased participation in physical activity. Finally, a few studies have indicated that physical activity is unrelated to academic performance. For example, a study that relied on the self-reported teacher perception of students’ physical activity did not find a relation with academic performance. However, another study reported that pupils who engaged in vigorous physical activity performed better in school than those that performed moderate or no physical activity. Sallis et al. observed a trend for improved achievement test scores following physical activity, but the relationship might have been blunted because the school district examined was one with historically high test scores. Collectively these data indicate that, at the very least, time spent in physical activity programmes does not hinder academic performance, and it might indeed improve performance. Given the positive health benefits that are derived from physical activity, these studies support PE as an important component of children’s health and wellbeing.

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Exercise and Children’s Intelligence, Cognition, and Academic Achievement:

Summary of findings of Prospective and Experimental Studies performed to assess the Chronic Effects of Exercise on Children’s Intelligence, Cognition, and Academic Achievement:

Author(s) n Sample Design Exercise intervention Duration Tests Results
Exercise and children’s intelligence
Corder (1966) 8 12–16 years, MR R Balance and coordination 20 days WISC Inconclusive
Brown (1967) 40 12 years, MR R Strength training 6 weeks Stanford–Binet Improvement
Ismail (1967) 142 10–12 years R Enhanced school PE Academic year Vineland Otis Improvement No effect
Exercise and cognition
Tuckman and Hinkle (1986) 154 9–12 years R Aerobic running 12 weeks Perceptual-motor No effect
Hinkle et al. (1993) 42 13–14 years R Aerobic running 8 weeks Creativity Improvement
Zervas et al. (1991) 26 11–14 years R Aerobic exercise 6 months Design matching Inconclusive
Davis et al. (2007) 30 8–10 years R Aerobic exercise 10–15 weeks CAS: executive Non-executive Improvement No effect
Exercise and academic achievement
Ismail (1967) 142 10–12 years R Enhanced school PE Academic year SAAT Improvement
Shephard et al. (1984) 546 First–sixth grade NR Enhanced school PE Academic year Class grades Inconclusive
Dwyer et al. (1983) ~500 Fifth grade NR Aerobic exercise Academic year ACER
GAP
No effect
No effect
Sallis et al. (1999) 759 K-fifth grade NR Enhanced school PE Academic year MAT Inconclusive
Coe et al. (2006) 214 Sixth grade R Enhanced school PE 4 months TN No effect

n number of participants, MR mental retardation, R Random assignment, NR Non-random assignment, WISC Wechsler Intelligence Scale for Children, CAS Cognitive Assessment System, SAAT Stanford Academic Achievement Test, ACER Arithmetic Test Form C, GAP Reading Comprehension Test, MAT Metropolitan Achievement Test, TN Terra Nova Test

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Similar to adults, exercise facilitates children’s executive function (i.e., processes required to select, organize, and properly initiate goal-directed actions). Exercise may prove to be a simple, yet important, method of enhancing those aspects of children’s mental functioning central to cognitive development.

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This study shows that physically active students have higher brain activities:

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Regular participation in physical activity and higher levels of physical fitness have been linked to improved academic performance and brain functions, such as attention and memory. These brain functions are the foundation for learning. Long-term studies have demonstrated that increases in physical activity, resulting from greater time spent in physical education, were related to improved academic performance. Even single sessions of physical activity have been associated with better scores on academic tests, improved concentration, and more efficient transfers of information from short- to long-term memory. Children participating in physical activity are better able to stay focused and remain on task in the classroom, thus enhancing the learning experience.

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The medical journal Pediatrics published research that found kids who took part in a regular physical activity program showed important enhancement of cognitive performance and brain function. The findings, according to University of Illinois professor Charles Hillman and colleagues, “demonstrate a causal effect of a physical program on executive control, and provide support for physical activity for improving childhood cognition and brain health.”  Physical activity is clearly a high-yield investment for all kids, but especially those attentive or hyperactive. The improvements in this case came in executive control, which consists of inhibition (resisting distraction, maintaining focus), working memory, and cognitive flexibility (switching between tasks). The images below show the brain activity in the group of kids who did the program as opposed to the group that didn’t. It’s the kind of difference that’s so dramatic it’s a little unsettling. The study only lasted nine months, but when you’re only seven years old, nine months is a long time to be sitting in class with a blue head.

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Electrophysiological plots representing brain processing capacity and mental workload (P3 amplitude) during cognitive tasks that require executive control in children in the experiment and control groups. Red represents the greatest amplitude, and blue the lowest.

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Acute aerobic exercise increases cortical activity during working memory: a functional MRI study in female college students: 2014:

There is increasing evidence that acute aerobic exercise is associated with improved cognitive function. However, neural correlates of its cognitive plasticity remain largely unknown. The present study examined the effect of a session of acute aerobic exercise on working memory task-evoked brain activity as well as task performance. Specifically, acute exercise induced increased brain activation in the right middle prefrontal gyrus, the right lingual gyrus, and the left fusiform gyrus as well as deactivations in the anterior cingulate cortexes, the left inferior frontal gyrus, and the right paracentral lobule. Despite the lack of an effect on behavioral measures, significant changes after acute exercise with activation of the prefrontal and occipital cortexes and deactivation of the anterior cingulate cortexes and left frontal hemisphere reflect the improvement of executive control processes, indicating that acute exercise could benefit working memory at a macro-neural level. In addition to its effects on reversing recent obesity and disease trends, these results provide substantial evidence highlighting the importance of promoting physical activity across the lifespan to prevent or reverse cognitive and neural decline.

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Brain activation maps during the performance of the N-back task in the exercise session and the control session. Red areas indicate greater activation during the N-back condition relative to the resting condition.

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Mental health:

The evidence on the mental health benefits of physical activity is less well documented than for the physical effects – as the editors of the journal Mental Health and Physical Activity put it, in the journal’s inaugural editorial: ‘So many research questions come to mind in this field that have barely been considered.’  However, the body of evidence is growing fast, with many studies and clinical trials having shown specific benefits including: improved mood, reducing symptoms of stress, anger and depression, alleviating anxiety and slowing cognitive decline. One of the ways exercise promotes mental health is by normalizing insulin resistance and boosting natural “feel good” hormones and neurotransmitters associated with mood control, including endorphins, serotonin, dopamine, glutamate, and GABA. Much research has focused on adults, but there is evidence that among adolescents increased leisure-time physical activity (i.e. outside structured school programmes) is significantly associated with fewer depressive symptoms over a two-year period.

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Exercise and mental stress:

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Exercise is a form of physical stress. Can physical stress relieve mental stress? Alexander Pope thought so: “Strength of mind is exercise, not rest.” Plato agreed: “Exercise would cure a guilty conscience.”  The “stress hormone”, cortisol, is a glucocorticoid that binds to glucocorticoid receptors.  Psychological stress induces the release of cortisol from the adrenal gland by activating the hypothalamic–pituitary–adrenal axis (HPA axis). Short-term increases in cortisol levels are associated with adaptive cognitive improvements, such as enhanced inhibitory control; however, excessively high exposure or prolonged exposure to high levels of cortisol causes impairments in cognitive control and has neurotoxic effects in the human brain.  For example, chronic psychological stress decreases BDNF expression which has detrimental effects on hippocampal volume and can lead to depression.  As a physical stressor, aerobic exercise stimulates cortisol secretion in an intensity-dependent manner; however, it does not result in long-term increases in cortisol production since this exercise-induced effect on cortisol is a response to transient negative energy balance. Individuals who have recently exercised exhibit improvements in stress coping behaviors. Aerobic exercise increases physical fitness and lowers neuroendocrine (i.e., HPA axis) reactivity and therefore reduces the biological response to psychological stress in humans (e.g., reduced cortisol release and attenuated heart rate response). Exercise also reverses stress-induced decreases in BDNF expression and signalling in the brain, thereby acting as a buffer against stress-related diseases like depression.  Exercise also promotes production of neurohormones like norepinephrine that are associated with improved cognitive function, elevated mood and learning. And that can improve thinking dulled by stressful events. Exercise forces the body’s physiological systems — all of which are involved in the stress response — to communicate much more closely than usual: The cardiovascular system communicates with the renal system, which communicates with the muscular system. And all of these are controlled by the central and sympathetic nervous systems, which also must communicate with each other. This workout of the body’s communication system may be the true value of exercise; the more sedentary we get, the less efficient our bodies in responding to stress.

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Does Aerobic Exercise reduce Stress Responses?

Physical exercise has become increasingly popular as a leisure-time activity, in part due to its potential health benefits. In particular, physical activity has been shown to decrease the risk of cardiovascular disease. The cardioprotective effects of exercise may be due to a reduction in cardiac risk factors, such as obesity, hyperlipidemia, and hypertension. In addition, exercise may reduce cardiovascular risk by attenuating cardiovascular and neuroendocrine responses to psychosocial Stressors. It has been shown that improved aerobic fitness is associated with altered cardiovascular and sympathoadrenal functioning. Specifically, decreased heart rate at rest and during exercise, as well as decreased plasma concentrations of epinephrine and norepinephrine during exercise, result from aerobic training. It is believed that these cardiovascular and hormonal changes are related to decreased sympathetic activity and increased vagal tone following aerobic training. In addition to altering physiologic activity at rest and during physical work (i.e., exercise), it is hypothesized that exercise also may modulate cardiovascular responses to psychological stress.

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Social exercise and stress relief:

Does exercising with another enhance the Stress-Reducing benefits of Exercise? A 2001 study:

This study sought to determine if the stress-reducing benefits of exercise are improved by exercising with others rather than alone. Results suggest that exercise with someone may be calming but more tiring due to a potential increased competition or workload.

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Depression:

Physical exercise, particularly aerobic exercise, has pronounced long-term antidepressant effects and can produce euphoria in the short-term. Numerous systematic reviews suggest that regular aerobic exercise (at sufficient intensity and duration) has comparable antidepressant efficacy to standard pharmaceutical antidepressants in treating depression. Consequently, current medical evidence supports the use of aerobic exercise as a treatment for depression. The biomolecular basis for exercise-induced antidepressant effects is believed to be a result of increased neurotrophic factor signalling, particularly brain-derived neurotrophic factor. Continuous exercise can produce short-term euphoria, colloquially known as a “runner’s high” in distance running or a “rower’s high” in crew, through the increased biosynthesis of at least three euphoriant neurochemicals: anandamide (an endocannabinoid), β-endorphin (an endogenous opioid), and phenethylamine (a trace amine and amphetamine analogue).

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Exercise for depression: Cochrane review 2013:

The 2013 Cochrane Collaboration review on physical exercise for depression noted that, based upon limited evidence, it is more effective than a control intervention and comparable to psychological or antidepressant drug therapies. Three subsequent 2014 systematic reviews that included the Cochrane review in their analysis concluded with similar findings: one indicated that that physical exercise is effective as an adjunct treatment (i.e., treatments that are used together) with antidepressant medication; the other two indicated that physical exercise has marked antidepressant effects and recommended the inclusion of physical activity as an adjunct treatment for mild–moderate depression and mental illness in general. One review asserted that evidence from clinical trials supports the efficacy of physical exercise as a treatment for depression over 2–4 months.

What does the evidence from the review tell us?

Exercise is moderately more effective than no therapy for reducing symptoms of depression.

Exercise is no more effective than antidepressants for reducing symptoms of depression, although this conclusion is based on a small number of studies.

Exercise is no more effective than psychological therapies for reducing symptoms of depression, although this conclusion is based on small number of studies.

The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.

Attendance rates for exercise treatments ranged from 50% to 100%.

The evidence about whether exercise for depression improves quality of life is inconclusive.

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Exercise and Anxiety:

Anxiety is “distress or uneasiness of mind caused by fear of danger or misfortune.” It is a stage of apprehension. The results of over 30 published papers substantiate an indisputable link with exercise (acute and chronic) and the reduction of anxiety. Most of the research on exercise and anxiety has been of an aerobic nature. The few studies with resistance training and flexibility have actually shown a slight increase in anxiety, but more research in this area is warranted. In regards to the actual aerobic exercise prescription, there appears to be much debate as to whether low-intensity (40-50% maximum heart rate [MHR]), moderate intensity (50-60% MHR), or high intensity (70-75% MHR) is most beneficial. The best compromise from the research suggests that exercise intensity be set at an adjustable level agreed upon by the individual in consultation with a physician (or health practitioner). It appears that even short bursts of 5 minutes of aerobic exercise will stimulate antianxiety effects. The research also indicates that those individuals training for periods of 10 to 15 weeks will receive the greatest beneficial effects.

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Exercise and Mood State:

It appears that aerobic and anaerobic exercise can positively help effect different mood states including tension, fatigue, anger and vigor in normal and clinical populations. Mood state is affected by psychosocial, psychophysiological, and pharmacological factors that make explaining the exercise-induced mechanism quite difficult.

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Exercise and Self Esteem:

As with the other psychological health variables, exercise has a positive connection in improving self-esteem. This link also appears to be mightier with those who have lower self-esteem. At this time, it appears that aerobic exercise may have a more pronounced effect, perhaps because there is so little research available with resistance training exercise and self-esteem. However, self-esteem is quite complex and studies suggest that certain subcomponents exist such as perceived sport competence, physical condition, attractive body, and strength, which may differ within a person. In other words, a person may highly value their physical condition and yet have a negative evaluation of their body.

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Sleep:

A 2010 review of published scientific research suggested that exercise generally improves sleep for most people, and helps sleep disorders such as insomnia. The optimum time to exercise may be 4 to 8 hours before bedtime, though exercise at any time of day is beneficial, with the possible exception of heavy exercise taken shortly before bedtime, which may disturb sleep. There is, in any case, insufficient evidence to draw detailed conclusions about the relationship between exercise and sleep. According to a 2005 study, exercise is the most recommended alternative to sleeping pills for resolving insomnia. Sleeping pills are more costly than to make time for a daily routine of staying fit, and may have dangerous side effects in the long run. Exercise can be a healthy, safe and inexpensive way to achieve more and better sleep.

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Learning:

Exercise increases the level of brain chemicals called growth factors, which help make new brain cells and establish new connections between brain cells to help us learn. Interestingly, complicated activities, like playing tennis or taking a dance class, provide the biggest brain boost. You’re challenging your brain even more when you have to think about coordination. Like muscles, you have to stress your brain cells to get them to grow. Complicated activities also improve our capacity to learn by enhancing our attention and concentration skills, according to German researchers who found that high school students scored better on high-attention tasks after doing 10 minutes of a complicated fitness routine compared to 10 minutes of regular activity. (Those who hadn’t exercised at all scored the worst.)

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Creativity:

Exercise can also boost your creativity, and help you come up with new solutions to problems. For example, researchers at Stanford University found that walking can increase creativity up to 60 percent.  Even a casual stroll around your office can be helpful.  According to the authors: “Four experiments demonstrate that walking boosts creative ideation in real time and shortly after… Walking opens up the free flow of ideas, and it is a simple and robust solution to the goals of increasing creativity and increasing physical activity.”

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Exercise and intelligence:

No study has ever demonstrated the impairment of intellectual performances from increases in physical activity. However, the bulk of studies show that physical activity does not increase basic intelligence, but may improve academic performance. Studies of children with mental retardation that looked at the role of physical activity in improving intelligence showed that there was no gain in intelligence scores and no improvement in academic performances. However, an improved body image was observed in children with mental handicaps when they participated in regular physical activity.  A 2009 Swedish study found that – on average – young men who moved in their percentile ranking for cardiovascular fitness also moved in their percentile ranking for intelligence. In other words, changes in intelligence from age 15 to age 18 seem to track changes in fitness. A likely biological mechanism behind the observed effect relates to the impact of physical exercise on the brains plasticity (the brain’s ability to adapt new situations and environments), and one of the physiological mediators for this mechanism may be the simple fact of improved blood circulation among those who exercise more.

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Regular exercise has many psychological and emotional benefits, too. It can help you:

•Gain confidence. Meeting exercise goals or challenges, even small ones, can boost your self-confidence. Getting in shape can also make you feel better about your appearance.

•Take your mind off worries. Exercise is a distraction that can get you away from the cycle of negative thoughts that feed anxiety and depression.

•Get more social interaction. Exercise and physical activity may give you the chance to meet or socialize with others. Just exchanging a friendly smile or greeting as you walk around your neighborhood can help your mood.

•Cope in a healthy way. Doing something positive to manage anxiety or depression is a healthy coping strategy. Trying to feel better by drinking alcohol, dwelling on how badly you feel, or hoping anxiety or depression will go away on its own can lead to worsening symptoms.

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Exercise as ADHD Medication:

Physical movement improves mental focus, memory, and cognitive flexibility; new research shows just how critical it is to academic performance. Mental exercises to build (or rebuild) attention span have shown promise recently as adjuncts or alternatives to amphetamines in addressing symptoms common to Attention Deficit Hyperactivity Disorder (ADHD). Building cognitive control, to be better able to focus on just one thing, or single-task, might involve regular practice with a specialized video game that reinforces “top-down” cognitive modulation, as was the case in a popular paper in Nature.

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Exercise and autism:

One of the most effective treatments for autistic people is exercise. Studies show that vigorous or strenuous exercise is associated with decreases in stereotypic (self-stimulatory) behaviors, hyperactivity, aggression, self-injury, and destructiveness. Vigorous exercise means a 20-minute or longer aerobic workout, 3 to 4 days a week; mild exercise has little effect on behavior. Many autistic children gain weight if they have an inactive life-style, and weight gain brings another set of problems. In general, exercise is important for both physical and mental health. A number of studies have shown that vigorous exercise is one of the best treatments for depression. Exercise can reduce stress and anxiety as well as improve sleep, reaction time, and memory. Since stereotypic behaviors interfere with teaching, an exercise program might improve the student’s attention in the classroom. Since exercise is inexpensive, safe, and healthful, it makes sense to try an exercise program to reduce behavior problems rather than to use more expensive and possibly harmful treatments, such as drugs.

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Exercise and substance use disorder:

Epidemiological studies reveal that individuals who report risky substance use are generally less likely to meet physical activity guidelines (with the exception of certain population segments, such as adolescents and athletes). A growing body of evidence suggests that individuals with substance use disorders (SUDs) are interested in exercising and that they may derive benefits from regular exercise, in terms of both general health/fitness and SUD recovery. Numerous theoretical and practical reasons support exercise-based treatments for SUDs, including psychological, behavioral, neurobiological, nearly universal safety profile, and overall positive health effects. Similar to other natural rewards and addictive drugs, consistent aerobic exercise increases gene expression of the gene transcription factor that causes and maintains addiction, ΔFosB, in the nucleus accumbens;  however, exercise also increases c-Fos expression as well, thereby opposing the long-term accumulation of ΔFosB. Clinical and preclinical evidence indicate that consistent aerobic exercise, especially endurance exercise (e.g., marathon running), actually prevents the development of certain drug addictions and is an effective adjunct treatment for drug addiction, and for psychostimulant addiction in particular. Consistent aerobic exercise magnitude-dependently (i.e., by duration and intensity) reduces drug addiction risk, which appears to occur through the reversal of drug induced addiction-related neuroplasticity.  In particular, aerobic exercise decreases psychostimulant self-administration, reduces the reinstatement (i.e., relapse) of drug-seeking, and induces opposite effects on striatal dopamine receptor D2 (DRD2) signalling (increased DRD2 density) to those induced by pathological stimulant use (decreased DRD2 density). Consequently, consistent aerobic exercise leads to better treatment outcomes when used as an adjunct treatment for addiction.

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Juvenile delinquency:

According to the majority of scientific studies, juvenile delinquency among athletic groups is less than that in the nonathletic population. There are some theories, proposed as an explanation. These theories include the following:

•the surplus energy theory (excess energy needs to be spent, and activity allows subjects to ‘blow off steam’);

•the stimulus-seeking theory (the excitement and thrills resulting from physical activity satisfy the increased need for stimulation); and

•the boredom theory (sport provides an alternative to occupy a time void, and by participating in physical activities, the child is too tired and too occupied to have energy left for delinquent behaviour).

Positive family interactions as a result of exercise may also be a contributing factor in explaining the reduced incidence of delinquency among physically active children and youth.

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Character development:

Athletic competition does not appear to promote character development; instead, there are some studies that suggest that individuals with athletic experience have poorer attitudes toward fair play. Socially desirable behaviours such as friendliness, generosity and cooperation are inconsistent with physical activities that emphasize winning. However, physical activity may have the potential for personal growth in qualities including persistence, deeper self-reliance, commitment and motivation, and may increase resourcefulness. This is probably truer for noncompetitive physical activities than team competition.

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Exercise may not help brain: a contrary study of 2015:

Exercise can help the heart, lower the risk of diabetes, keep blood pressure in check and help you maintain a healthy weight. But researchers say you shouldn’t expect it to keep your brain alert. In a study published in JAMA, Dr. Kaycee Sink, director of the memory assessment clinic at Wake Forest Baptist Medical Center and her colleagues come to the somewhat surprising conclusion that exercise doesn’t help elderly to maintain their brain function. Previous studies that found people who were more active documented less decline in mental abilities over time. And the theory behind the relationship made sense — physical activity can improve circulation and keep brain neurons nourished and fed with the nutrients they need to keep working properly. But when Sink and her team put the idea to the test with a group of 1,635 elderly, sedentary people aged 70 to 89 years, they found that exercise didn’t provide the benefits they expected for most people. The participants were randomly assigned to either a moderately vigorous exercise regimen of walking or a health education program that was interactive but didn’t involve as much physical activity. After two years, the scores on a battery of cognitive function tests for the two groups were about the same. The relationship held even after the researchers adjusted for the potential effects of other factors that could contribute to cognitive abilities. The idea that exercise doesn’t help the brain “flies in the face of conventional wisdom,” says Sink. Because the volunteers in the study were older, Sink says that the exercise may not have started early enough or lasted long enough for it to have significant effects on the brain. “We certainly can’t rule out that exercise is something that needs to start earlier,” she says. “Lifelong healthy habits are probably important.” And, she says, there are other health benefits of exercise beyond the brain. “Even though we couldn’t prove that exercising is better for the brain than attending education classes, exercise is still good for the body in m any ways,” she says. “So I would say to continue to exercise and stay physically active, but also try to stay cognitively and socially active as well.”

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Exercise and aging:

Does Exercise slow the Aging Process?

Dating a cell’s age is tricky, because its biological and chronological ages rarely match. A cell could be relatively young in terms of how long it has existed but function slowly or erratically, as if elderly. Today, many scientists have begun determining a cell’s biological age — meaning how well it functions and not how old it literally is — by measuring the length of its telomeres. Telomeres are tiny caps found on the end of DNA strands, like plastic aglets on shoelaces. They are believed to protect the DNA from damage during cell division and replication. As a cell ages, its telomeres naturally shorten and fray. But the process can be accelerated by obesity, smoking, insomnia, diabetes and other aspects of health and lifestyle. In those cases, the affected cells age prematurely. However, recent science suggests that exercise may slow the fraying of telomeres. Past studies have found, for instance, that master athletes typically have longer telomeres than sedentary people of the same age, as do older women who frequently walk or engage in other fairly moderate exercise. But those studies were relatively narrow, focusing mostly on elderly people who ran or walked. It remained unclear whether people of different ages who engaged in a variety of exercises would likewise show effects on their telomeres. So in the new study, which was published in Medicine & Science in Sports & Exercise, researchers from the University of Mississippi and University of California, San Francisco, decided to look more broadly at the interactions of exercise and telomeres among a wide swath of Americans? To do so, they turned to the immense trove of data generated by the ongoing National Health and Nutrition Examination Survey, for which tens of thousands of adults answer questions annually about their health, including their exercise habits, and complete an in-person health exam, providing a blood sample. In recent years, those blood samples have been tested for, among other markers of health, telomere length in the participants’ white blood cells. The researchers gathered the data for about 6,500 of the participants, ranging in age from 20 to 84, and then categorized them into four groups, based on how they had responded to questions about exercise. Those questions in this survey tended to be broad, asking people only if, at any time during the past month, they had engaged in weight training, moderate exercise like walking, more vigorous exercise like running, or have walked or ridden a bike to work or school. If a participant answered yes to any of those four questions, he or she earned a point from the researchers. So, someone who reported walking received a point. If he also ran, he earned another, and so on, for a maximum of four points. The researchers then compared those tallies to each person’s telomere length. And there were clear associations. For every point someone gained from any type of exercise, his or her risks of having unusually short telomeres declined significantly. Specifically, someone who participated in a single activity, earning them a 1, was about 3 percent less likely to have very short telomeres than someone who didn’t exercise at all. That risk declined more substantially if someone exercised more. People who reported two types of exercise were 24 percent less likely to have short telomeres; three types of exercise were 29 percent less likely; and those who had participated in all four types of activities were 59 percent less likely to have very short telomeres. Interestingly, these associations were strongest among people between the ages of 40 and 65, the researchers found, suggesting that middle age may be a key time to begin or maintain an exercise program if you wish to keep telomeres from shrinking.  However this study is purely associational, so cannot show whether exercise actually causes changes in telomere length, only that people who exercise have longer telomeres. Perhaps most important, the results don’t tell us whether longer telomeres translate into better health.

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Non-health benefits of exercise:

Social Benefits

•boost self-confidence and help prevent depression

•Regular exercise can even help with the treatment of depression and anxiety

•As muscle definition is improved and body fat reduced, this can help to make you feel better about your appearance

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Economic Benefits

•Perform better at work as you have a greater mental and physical ability

•Motivation improved leads to increased productively and efficiency

•Annual costs of physical inactivity in England to be in the region of £8.2 billion; costs of obesity alone being a further £2.5 billion.

•Sickness absence costs employers a minimum of £18 billion each year in England, which roughly equates to 16% of salary costs.

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Exercise reduces absenteeism:

By improving your overall health, exercise can help you ward off both acute and chronic illness. You’ll get fewer colds, be less prone to the flu, and avoid the accidents or surgical interventions that can force you to take prolonged absences. In a tough economy, you need every edge you can get, and by showing up for work every day, you’ll maintain that edge over your absentee-prone non-exercising co-workers.

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Exercise reduces exertion at work:

High physical exertion during work is a risk factor for musculoskeletal pain and long-term sickness absence. Physical exertion reflects the balance between physical work demands and physical capacity of the individual. Thus, increasing the physical capacity through physical exercise may decrease physical exertion during work. A 2014 study found that physical exercise performed at the workplace appears more effective than home-based exercise in reducing physical exertion during daily work tasks in healthcare workers.

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The Cost of “Unfitness”:

Studies show that a lack of fitness in North American society has a severely negative economic impact. And in the United States, more than half of the $623 billion spent on health care annually went to treat preventable conditions – with at least one-quarter of the total cost reflecting adverse personal life-styles. Translated into dollars and time, the significance of inactivity, or being unfit, is staggering. According to the comprehensive California study on Economic Costs of Physical Inactivity, Obesity and Overweight (2005), the incremental cost to the employer of a physically inactive worker is $2,400/year; and $3,270 for an obese worker.

Risk Factor Population Incremental Incidence Cost/Employee/Year*
Inactive 50% $2,400
Obese** 17.5% $3,270
Overweight 35% $515

*Cost: Medical 50% / Productivity 50%
**Rate of obesity is growing at 4.5% per Year

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Exercise and happiness:

The graph above shows that the more frequent your workouts, the happier you’ll be, according to Jawbone data. The happiest people exercise six or seven days per week.

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Exercise builds self-esteem and improves body image:

You don’t need to radically change your body shape to get a confidence surge from exercise. Studies suggest that simply seeing fitness improvements, like running a faster mile or lifting more weight than before, can improve your self-esteem and body image.

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Does physical exercise affect demand for hospital services? Evidence from Canadian panel data: 2011:

Recent epidemiological literature shows that regular physical activity is effective in preventing several chronic diseases, and is associated with a reduced risk of premature death. The results show that physical exercise decreases the demand for hospital services, and its marginal effect decreases as physical activity increases.

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Lack of exercise (physical inactivity):

Worldwide there has been a large shift towards less physically demanding work. This has been accompanied by increasing use of mechanized transportation, a greater prevalence of labor saving technology in the home, and less active recreational pursuits. Globally, around 31% of adults aged 15 and over were insufficiently active in 2008 (men 28% and women 34%). Approximately 3.2 million deaths each year are attributable to insufficient physical activity. In 2008, prevalence of insufficient physical activity was highest in the WHO Region of the Americas and the Eastern Mediterranean Region. In both these regions, almost 50% of women were insufficiently active, while the prevalence for men was 40% in the Americas and 36% in Eastern Mediterranean. The South East Asian Region showed the lowest percentages (15% for men and 19% for women). In all WHO Regions, men were more active than women, with the biggest difference in prevalence between the two sexes in Eastern Mediterranean. This was also the case in nearly every country. Globally, 81% of adolescents aged 11-17 years were insufficiently physically active in 2010. Adolescent girls were less active than adolescent boys, with 84% vs. 78% not meeting WHO recommendations.  Some experts refer to sitting as “the new smoking” because of its negative effects on overall health. These exercise trends are contributing to the rising rates of chronic diseases including: obesity, heart disease, stroke and high cholesterol.  Active transport (walking, bicycling, etc.) has been found to be inversely related to obesity in Europe, North America, and Australia. Thus exercise has been associated with a decrease in mortality.

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Causes of lack of exercise:

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Common reasons why we don’t exercise:

1. I don’t have enough time to exercise.

2. Exercise is too difficult and painful.

3. I’m too tired to exercise.

4. I’m too old to start exercising, I’m too fat, my health isn’t good enough.

5. I’m not athletic.

6. Exercise is boring.

7. I can never stick with an exercise routine long enough to reap the benefits.

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One of the causes most prevalent in the developing world is urbanization. As more of the population moves to cities, population over-crowding, increased poverty, increased levels of crime, high-density traffic, low air quality and lack of parks, sidewalks and recreational sports facilities leads to a less active lifestyle. Physical inactivity is increasing or high among many groups in the population including: young people, women, and the elderly.  A 2005 population study in south Brazil showed physical inactivity during leisure time to be more prevalent among females and those living with a partner; with a positive correlation associated with age and number of cigarettes smoked, and a negative correlation (decreased levels of physical inactivity) associated with years of formal education, body mass index, and increasing socioeconomic status.  Studies in children and adults have found an association between the number of hours of television watched and the prevalence of obesity.  A 2008 meta-analysis found that 63 of 73 studies (86%) showed an increased rate of childhood obesity with increased media exposure, and rates increasing proportionally to time spent watching television.  Another cause in the case of children is that physical activity in activities from self-propelled transport, to school physical education, and organized sports is declining in many countries. . Barriers to physical activity include perceived lack of time, lack of resources, family obligations and embarrassment. For many, pain, injury and disability encourage sedentary behavior. A lack of energy, motivation and confidence are among the top reasons adults cite for not adopting a more physically active lifestyle.

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Exercise varies between different socio-economic groups:

There have been some studies into why patterns of physical activity vary between different socioeconomic groups – and there are certainly intuitive reasons why this may be so, even where strong empirical evidence is lacking. For example, the streets in poorer neighbourhoods are often less safe for walking or cycling because of traffic and a perceived fear of crime. The infrastructure for active living may also not be in place in such areas: one study in the United States found that ‘moving from a community with a 1% poverty rate to a 10% poverty rate is associated with a decreased prevalence of bike paths from 57% to 9% respectively – as the area got poorer, the availability of bike paths fell dramatically. In addition, access both to attractive, safe green space and to commercial resources for structured physical activity such as gyms may be more limited in some more deprived areas.

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Contributors to Sedentary Behavior:

The physical and social environments in which we live are changing in ways that reduce the demand for physical activity. Common behaviors that contribute to inactivity include TV viewing, computer use and electronic gaming. People of all ages are spending more time interacting with technology: the Internet, video games, cell phones and MP3 players. Drive-through windows, elevators, escalators and automation have made our lives more efficient, but less active.

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Effects of lack of exercise:

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How to increase physical activity?

Both, society in general and individuals can take action to increase physical activity.

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Policies to increase physical activity aim to ensure that:

•in cooperation with relevant sectors physical activity is promoted through activities of daily living;

•walking, cycling and other forms of active transportation are accessible and safe for all;

•labour and workplace policies encourage physical activity;

•schools have safe spaces and facilities for students to spend their free time actively;

•quality physical education supports children to develop behaviour patterns that will keep them physically active throughout their lives; and

•sports and recreation facilities provide opportunities for everyone to do sports.

Policies and plans to address physical inactivity have been developed in about 80% of WHO Member States, though these were operational in only 56% of the countries in 2013. National and local authorities are also adopting policies in a range of sectors to promote and facilitate physical activity.

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WHO response:

The “Global Strategy on Diet, Physical Activity and Health”, adopted by the World Health Assembly in 2004, describes the actions needed to increase physical activity worldwide. The Strategy urges stakeholders to take action at global, regional and local levels to increase physical activity. The “Global Recommendations on Physical Activity for Health”, published by WHO in 2010, focus on primary prevention of NCDs through physical activity. It proposes different policy options to reach the recommended levels of physical activity globally, such as:

•the development and implementation of national guidelines for health-enhancing physical activity;

•the integration of physical activity within other related policy sectors, in order to secure that policies and action plans are coherent and complementary;

•the use of mass media to raise awareness of the benefits of being physically active;

•the surveillance and monitoring of actions to promote physical activity.

• Global recommendations: physical activity for health

In 2013, the World Health Assembly agreed on a set of global voluntary targets which include a 25% reduction of premature mortality from NCDs and a 10% decrease in insufficient physical activity by 2025. The “Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020” guides Member States, WHO and other UN Agencies on how to effectively achieve these targets. A sector specific toolkit is under development by WHO to assist Member States implement actions and achieve the targets.  WHO has established several partnerships to help support Member States in their efforts to promote physical activity – these include the United Nations Educational, Scientific and Cultural Organization (UNESCO) and United Nations Sport for Development and Peace (UNOSPD) and a Memo of Understanding with the International Olympic Committee (IOC).

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Public health measures to increase physical activity:

Multiple component community-wide campaigns are a popular approach to increasing the population’s level of physical activity.  A Cochrane review of public health measures included 267 studies from a total of 33 countries in both high (n=25) and low/middle income countries (n=8). Many of the studies were of poor quality, although four studies were judged as trustworthy. Partnerships with local governments and non-government agencies were a popular feature, along with mass-media strategies. When the reviewers looked across all the studies, it was noticed that there was little reporting of benefit (including within the trustworthy studies). Environmental approaches appear promising: Signs that encourage the use of stairs, as well as community campaigns, may increase exercise levels. The city of Bogotá, Colombia, for example, blocks off 113 kilometers (70 mi) of roads on Sundays and holidays to make it easier for its citizens to get exercise. These pedestrian zones are part of an effort to combat chronic diseases, including obesity.

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Active living:

Role of exercise is a way of life that integrates physical activity into your everyday routines, such as walking to the store or biking to work. Active living brings together urban planners, architects, transportation engineers, public health professionals, activists and other professionals to build places that encourage active living and physical activity. One example includes efforts to build sidewalks, crosswalks, pedestrian crossing signals and other ways for children to walk safely to and from school, as seen in the Safe Routes to School program. Recreational opportunities (parks, fitness centres etc.) close to the home or workplace, walking trails and bike lanes for transportation also encourage a more active lifestyle. Active living is a combination of physical activity and recreation activities aimed at the general public to encourage a healthier lifestyle.

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Myth: Physical activity is needed only in industrialised countries. Developing countries have other problems.

Fact: Physical inactivity is now identified as the fourth leading risk factor for global mortality. Physical inactivity is also an independent risk factor for non-communicable diseases which caused more than 35 million deaths in 2005. Importantly, 80% of deaths from common NCDs occur in low- and middle-income countries. Therefore, non-communicable diseases associated with physical inactivity are a significant public health problem in most countries around the world. Levels of inactivity are high in virtually all developed and developing countries. In developed countries more than half of adults are insufficiently active. In rapidly growing large cities of the developing world, physical inactivity is an even greater problem. Urbanisation has resulted in several environmental factors which discourage participation in physical activity particularly in the transport and occupational domains. In rural areas of developing countries, sedentary pastimes (e.g. watching television) are also becoming increasingly popular.

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Exercise pill:

Exercising is one of the tried and tested methods for weight loss, but recently, scientists are reportedly developing an exercise pill that can supposedly give humans almost the same benefits of physical exercise.  With this new exercise pill, a lot of people would surely be interested to use it, especially those who do not want to get all sweaty and slave all over a treadmill, push-up bar or whatever workout contraption they might be already using.  Having an exercise pill offering benefits of physical exercise without any physical effort seems to be too good to be true, but exercise pill is a reality and is actually a serious scientific goal and researchers have already published a major breakthrough. Although the said exercise pill is not yet in production, the major breakthrough refers to the fact that the researchers have finally discovered and created a blueprint of the molecular reactions to exercise. Scientists have discovered that physical exercise cause around 1,000 molecular changes in skeletal muscles and according to Dr. Nolan Hoffman, one of the authors of the study and research associate at Sydney’s School of Molecular Bioscience, the main goal of their research is to identify the most important changes in the body so that it can be replicated through drugs. “We’ve created an exercise blueprint that lays the foundation for future treatments, and the end goal is to mimic the effects of exercise,” Dr. Hoffman says.  “It’s long been thought that there were many signals elicited by exercise, but we were the first to create this map and we now know the complexity,” he added. As of now, the researchers are working on identifying the most significant biological changes because the blueprint is said to be incredibly complicated.  Further, the results are still under analysis because no drug exists that could safely replicate the effects of physical exercise.  Despite the science behind it, Ismael Laher, a professor at the University of British Columbia and co-author of a second study about the subject, noted that the exercise pill, if ever one is created, should not be considered as a magical drug that can completely replace the benefits of being physically active. In other words, it will not be as effective as actual physical exercise paired with a healthy diet. But, for those who cannot engage in traditional exercise routines such as stroke victims and amputees, this type of pill could help them remain physically fit. Exercise requires your heart rate to go up, blood to flow faster, and you cannot do that with an exercise pill…but in particular groups, it’s the next best thing.  At first glance, this can seem like the greatest idea ever, but critics would say just the opposite: This could be a gateway to promoting the worst possible attitude people could have about exercise. An ‘exercise pill’ would be a perversion of science and a prescription for the promotion of unhealthy lifestyles.

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Harms of exercise:

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Most people believe that all exercises are good, safe and effective. The truth is that some common exercises aren’t safe at all (especially for people who have muscle, joint, and health problems). Certain exercises require a bit more know-how than the average person possesses. And other exercises are downright wastes of your time.  What you should do—or avoid—depends on your goals, fitness level, health history, workout schedule, and other personal issues. An article like this can’t replace your own efforts to identify your goals and needs. That requires you to do some research on your own, talk to your medical professional about any pain or physical limitations you have, and learn how to exercise with proper form and technique.

What makes an exercise risky? Here are a few red flags to look out for:

Any unusual or “unnatural” movement pattern in the exercise

Any movement that causes pain or discomfort in any way

Any movement that enhances muscular imbalances that are already present

Any movement that requires joint flexibility that is above and beyond your range of motion

Any exercise with risks of injury that outweigh the potential benefit of the exercise itself

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Costly fitness mistakes that could harm your body:

1. Forgetting the basics:

Eating, breathing and stretching are three basics that work together to keep you safe before, during and after your workout. Large meals are best avoided before a workout – better to snack on fresh fruit, energy bars or yoghurt. Remember to drink water before, during and after your workout Warming up means warming up your muscles, ready for a workout – as opposed to relaxing them, such as by massage.  The wrong kind of stretching can include stretching from the waist, which can put unnecessary strain on your back. It’s better to put your foot on an elevated surface, and then lean over to stretch the hamstrings. Yoga is also good for all-over stretching.

2. Right routine, wrong time:

Sometimes, do basic exercises such as lunges feel wrong for you?

A basic pre-exercise assessment from a fitness professional will determine your current fitness level, your bio-mechanical efficiency and your exercise needs.  You’ll get a schedule of the best exercises for you and great results from your workout.

3. Ignoring your pain:

Pain is an important warning sign, not an indication that you’re doing well. Enthusiasm can lead you to do too much, too soon, particularly when you start a new workout or fitness class.  Pain protects us from potential serious injuries, so take heed when it happens in your workout – and stop.

4. Repetition:

Doing the same exercise over and over again might make you very good at that one thing – but it can also lead to overuse injury.  That could mean you end up with problems with muscle imbalance or weakness, and even alignment problems. Varying your exercise training routine is the answer.

5. Poor technique:

Don’t hold on to the treadmill, whether you’re walking or running. That poor technique affects your natural posture – and can lead to some bad muscle strain.  A skilled fitness professional will show you the right technique and make exercise fun as well as correct.

6. Too much weight:

Short, intense workouts are designed to get fast results, especially in building strength and power. However, incorrect lifting of heavy weights will hurt you, while incorrect jumping technique can lead to serious injury to knees or Achilles tendons. Improper coaching and overtraining can multiply the problem. If you decide to do these extreme workouts, then choose a professional fitness trainer who can make sure you’re doing it correctly, and keeping safe from injury.

7. Aim to be well rounded:

Doing any exercise to exhaustion levels is unnecessary, and may even be dangerous. A well-rounded exercise routine should include various components, including strength, low-level aerobics, and interval training. Aim for an exercise programme that will accomplish your fitness goals without unnecessary fatigue.

8. Forgetting to stop:

This idea might seem counter to all the hard work you’re putting into your healthy workout, but do remember to take a rest – at least one day a week.  Your body needs time to recover. Respect your body and what it can do.

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Risks of Exercise:

As can be seen from the foregoing discussion, regular participation in an exercise program can provide several benefits. Yet exercise is similar to other medical or health interventions in that there are also potential costs associated with the activity. These costs range from minor inconveniences, such as time taken up by exercise, to more serious complications, including injury and even sudden death.

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Exercise and injury:

Overall, available information suggests that physical activity in the range recommended by recent public health guidelines, such as the CDC/ACSM guideline, has quite an acceptable risk-to-benefit ratio. The most common risk of physical activity in adults is musculoskeletal injury. The incidence of injury can be as high as 55% in 8 weeks among women undergoing US Army basic training. In contrast, injuries are rare in research studies of supervised exercise training among older adults when individuals at high risk of injury are excluded. In a cohort study of community adults aged 20 to 85 years with above-average activity levels, 25% reported a musculoskeletal injury over 1 year, and one third of injured adults stopped exercising. The best available studies on injury rates suggest that about 25 to 30 percent of adult runners will become injured over the course of a year, if injury is defined as an incident that causes an individual to stop exercising for at least one week. If only more serious injuries, such as those for which the individual seeks medical care, are considered, injury rates are much lower, perhaps in the range of 1 percent per year. Several factors affecting injury risk are modifiable and offer opportunities for risk management. Risk of injury increases with obesity, volume of exercise, and participation in vigorous exercise such as competitive sports, whereas higher fitness, supervision, stretching exercises, protective equipment such as bike helmets, and well-designed environments protect against injury. The general principle that the volume of physical activity should be increased gradually over time is widely regarded as critical for reducing injury risk. Walking, the most popular activity and the standard example of a moderate-intensity activity, is a low-risk activity. One study reported that increasing the duration of walking did not result in any increase in injury risk. In some situations, regular physical activity actually reduces injury risk, as indicated by a recent consensus statement that physical activity is recommended to reduce the risk of fall injuries in older adults. While one set of joints and muscles may have the tolerance to withstand multiple marathons, another body may be damaged by 20 minutes of light jogging. This must be determined by each individual.

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Take these steps to prevent injury:

•If you’re not active at all or have a health problem, start your program with short sessions (5 to 10 minutes) of physical activity and build up to your goal. (Be sure to ask a doctor before you start if you have a health problem.)

•Use safety equipment such as a helmet for bike riding or supportive shoes for walking or jogging.

•Start every workout with a warm-up. If you plan to walk at a brisk pace, start by walking at an easy pace for 5 to 10 minutes. When you’re done working out, do the same thing until your heart rate returns to normal.

•Drink plenty of fluids when you are physically active, even if you are not thirsty.

•Use sunscreen when you are outside.

•Always bend forward from the hips, not the waist. If you keep your back straight, you’re probably bending the right way. If your back “humps,” that’s probably wrong.

•Stop your activity if you feel very out of breath, dizzy, nauseous, or have pain. If you feel tightness or pain in your chest or you feel faint or have trouble breathing, stop the activity right away and talk to your doctor.

Exercise should not hurt or make you feel really tired. You might feel some soreness, a little discomfort, or a bit weary. But you should not feel pain. In fact, in many ways, being active will probably make you feel better.

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Exercise and sudden death:

Vigorous physical activity acutely increases the risk of sudden cardiac death and myocardial infarction among individuals with both diagnosed and occult heart disease. A variety of congenital and acquired conditions such as hypertrophic cardiomyopathy, coronary artery anomalies, aortic stenosis, and cardiomyopathies are associated with sudden death during vigorous activity in children and young adults. Recommendations for athletic screening and participation for these conditions have been presented in the AHA Statement on Cardiovascular Preparticipation Screening of Competitive Athletes. During exercise, there is a transient increase in the risk of having a cardiac-related complication (for example, a heart attack or serious heart rhythm disorder). However, this risk is extremely small. For adults without existing heart disease, the risk of a cardiac event or complication ranges between 1 in 400000–800000 hours of exercise. For patients with existing heart disease, an event can occur an average of once in 62000 hours. Among high school and college athletes, an estimated 1 death per year occurs during or within an hour after athletic activity for every 133333 male and 769230 female participants. Importantly, the risk of a cardiac event is significantly lower among regular exercisers. Evidence suggests that a sedentary person’s risk is nearly 50 times higher than the risk for a person who exercises about 5 times per week. Stated simply, individuals who exercise regularly are much less likely to experience a problem during exercise. Moreover, contrary to popular view, the majority of heart attacks (approximately 90%) occur in the resting state, not during physical activity.  Exercise is therefore considered to be extremely safe. Nevertheless, it is a good idea to be aware of the warning signs or symptoms that may indicate a problem: chest discomfort (pain or pressure in the chest, jaw, or neck, possibly radiating into the shoulder, arm, or back), unusual shortness of breath, dizziness or light-headedness, and heart rhythm abnormalities (sensations of heart beat skipping, palpitations, or thumping). If one of these symptoms occurs, medical attention should be sought immediately. High dose anabolic steroids and products containing ephedra have been associated with cases of stroke, heart attack, and even death.

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Although the absolute incidence of sudden death associated with exercise is quite low, exercise does acutely increase the rate of sudden death compared with more leisurely activities.  Exercise also transiently increases the risk of acute myocardial infarction.  Approximately 5% to 10% of myocardial infarctions are associated with vigorous physical activity. The relative risk of both exercise-related myocardial infarction and sudden death is greatest in individuals who are the least physically active and who were performing unaccustomed vigorous physical activity.  Sedentary adults should avoid isolated bouts of unaccustomed vigorous physical activity and should follow the standard recommendation to increase physical activity levels gradually over time. The possible value of this strategy is supported by the observation that the risk of exercise-related cardiac events is greatest in the least active individuals.  Because atherosclerotic CAD is the most frequent cause of exercise-related events, the incidence of such events is higher among patients with known atherosclerotic coronary disease. Among participants in cardiac rehabilitation programs, the average incidence of cardiac arrest, nonfatal myocardial infarction, and death is 1 for every 117000, 220000, and 750000 patient-hours of participation, respectively. The low ratio of cardiac arrest to death is due to the availability of acute medical care.

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Dehydration and Exercise: a dangerous combination:

Do you want to make the most of your workouts?  Drinking plenty of water is a necessity for both performance and safety during exercise.  On a basic level, even slight dehydration can cause decreased physical and mental capability, which can reduce the benefits of your workout.  Yes, drinking too little water can make you feel thirsty, but it can also cause dizziness, light-headedness, lack of energy, and muscle cramping.  Severe dehydration can lead to heat exhaustion, heat stroke, seizures, and even death. Exercise creates an increase in body temperature, which is cooled by sweating.  If your body isn’t properly hydrated, it is not able to properly cool itself.  Exercising outside in extreme heat?  Even more dangerous without enough fluid intake!  Fluids help with muscle contraction and blood flow – two things necessary for your body to receive the full benefits of physical activity.  Even physical activity such as swimming requires proper hydration, even if you do not feel hot or thirsty.   If you are working out, chances are your body will need a bit more fluid than daily requirement.  The best way to ensure proper hydration is to drink plenty of fluids not only during the workout, but also before and after any physical exercise.  Drinking a few glasses of water several hours before exercise allows your body to absorb the fluid and prepare itself for the upcoming stress.  Drinking water during exercise helps maintain a safe body temperature, and drinking water after helps your muscles recover.  If you will be working out for more than an hour, you may want to drink fluids that replace electrolytes (i.e. sports drinks). What is the easiest way to check for dehydration?  Check the color of your urine!  A darker color can mean that you aren’t getting enough water, whereas a light yellow to clear urine usually means that you are properly hydrated.  Another way to tell of you are depleting your fluid levels during exercise is to weigh before and after your workout.  If your weight is less after, then you need to increase your fluid intake. Exercise is a critical component of excellent overall health, and water is a necessary fuel for your body during exercise.  Water also has other benefits beyond merely hydration, such as making it easier to maintain a healthy weight, helping digestion, and can even contribute to clearer skin.  So grab your water bottle and drink to your health!

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Exercise produces heat. Prevention of overheating occurs by transfer of heat to the skin by vasodilation of the cutaneous circulation, and by the cooling effect of evaporation of sweat. Exercise causes body fluid losses from moisture in exhaled air as well as from sweating. Although sweat rates are highest under conditions of high-intensity exercise in heat and high humidity, total fluid losses can be appreciable in very prolonged events, whatever the conditions. Sweat rates of 2 to 3 litres/hour can be expected during short periods of hard exercise in the heat, and an excess of 1.5-2 litres/hour during endurance events. Even in cooler conditions losses are appreciable. During a football game on a cool day (10 deg. C), players can lose up to two litres of sweat, and runners are estimated to lose around 1.2 litres/hour at 6 minute/mile pace on a cool, dry day (double this amount on a hot, humid day). Additionally, fluid is lost via moisture in exhaled air. Except in extreme circumstances, blood Na levels are maintained during exercise. Sweat is mainly composed of water, and Na losses in sweat represent a small fraction of total body content and are readily replaced afterwards by normal food. Unless fluid losses are replaced by drinks, sweating causes progressive depletion of circulating blood volume, commonly called dehydration and a thickening of blood (increased viscosity). This places a strain on the cardiovascular system, with a rise in heart rate in order to maintain adequate blood flow to exercising muscles and vital organs. As blood volume depletes, blood flow to the skin is reduced. As a result, sweating decreases and heat dissipation from the skin is impaired, causing body core temperature to rise, potentially leading to heat stress, collapse and even death. Even low levels of dehydration have physiological consequences. A loss of 2% bodyweight (just 1kg for a 50kg person) causes an increase in perceived effort and is claimed to reduce performance by 10-20%. A fluid loss exceeding 3-5% bodyweight reduces aerobic exercise performance noticeably and impairs reaction time, judgement, concentration and decision making – vital elements in all sports, from pole-vaulting to football. A particular issue for boxers is that dehydration increases risk of brain injury.

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Exercise-induced nausea:

Exercise-induced nausea is a feeling of sickness or vomiting which can occur shortly after exercise has stopped as well as during exercise itself. It may be a symptom of either over-exertion during exercise, or from too abruptly ending an exercise session. People engaged in high-intensity exercise such as aerobics and bicycling have reported suffering from exercise-induced nausea. Lack of hydration during exercise is a well-known cause of headache and nausea during exercise. Exercising at a heavy rate causes blood flow to be taken away from the stomach, causing nausea. Another possible cause of exercise induced nausea is overhydration. Drinking too much water before, during, and/or after extreme exercise (such as a marathon) can cause nausea, diarrhea, confusion, and muscle tremors. Excessive water consumption reduces or dilutes electrolyte levels in the body causing hyponatremia.

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Frostbite in cold weather:

Precautions are also necessary in cold weather. When exercising in winter, dress in layers, including gloves and socks, which create insulated air pockets that trap heat. In cold weather, wear shoes with less ventilation than those worn in the summer. Fingers, toes, ears, and nose are most susceptible to frostbite. Frostbite progresses from stinging or aching to numbness. Fingers and toes may become white. Soaking the hands and feet in warm water can help, but only once there is no risk of refreezing, since a second bout of frostbite after thawing can quicken tissue damage.

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Exercise can break up families:

In 2010, The Wall Street Journal published the article “A Workout Ate My Marriage”, describing how couples become increasingly conflicted as a spouse becomes obsessed with a particular exercise goal, such as extreme weight loss or an Ironman triathlon – to the detriment of time spent with family. Often, since the exercise goal can be justified as “noble”, it is difficult for a spouse or family member to negotiate with the over-exerciser to spend more time with family. If your goals require you to exercise “excessively”, then at least attempt to include family in exercise. Join a gym with free childcare so you and the spouse can exercise together, get a jogging stroller and bicycle trailer, and train indoors with the kids at home so a spouse can go enjoy free time.

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Exercise is associated with body perception disorders:

Body dysmorphic disorder is a psychological disorder in which you are excessively concerned about a perceived defect in your physical features, such as your arm or leg muscles being too small or your waistline not being thin enough. This can result in heavy, often socially isolated exercise to “repair the defect”. Typically, this type of activity can begin in adolescence or early adulthood, but can stay with you your entire life as you strive to achieve or maintain the “perfect body”. You may turn to bodybuilding, marathoning, cycling or any other activity which uses the same muscles over and over again to try to hammer away at your perceived defects, even when it comes to the detriment of your joints or health. If you don’t have the time to exercise and address what you perceive to be a significant body issue, this can result in  depression, social anxiety, and even social phobia, or complete avoidance of being in public, especially where your body might be exposed. Often, you might justify your behavior by believing that you are a serious athlete who can never work too hard or too long at your sport, and this can often lead to excessive and addictive exercise in an attempt to control or lose weight, or sometimes to gain muscle or “sculpt” a body part.

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Stopping regular exercise suddenly can also create a change in mood. Feelings of depression and agitation can occur when withdrawal from the natural endorphins produced by exercise occurs. Exercise should be controlled by each body’s inherent limitations.

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Exercise intolerance:

Exercise intolerance is a condition of inability or decreased ability to perform physical exercise at the expected level or duration of someone with a specific physical condition. It also includes experiences of unusually severe post-exercise pain, fatigue, nausea, vomiting or other negative effects. Exercise intolerance is not a disease or syndrome in and of itself, but a primary symptom of chronic diastolic heart failure.  In most cases, the specific reason that exercise is not tolerated is of considerable significance when trying to isolate the cause down to a specific disease. Dysfunctions involving the pulmonary, cardiovascular or neuromuscular systems have been frequently found to be associated with exercise intolerance, with behavioural causes also playing a part in it.

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Over-exercise (excessive exercise/ overtraining):

Overtraining means the intensity or volume of training exceeds the body’s capacity to recover between bouts. Working out more than two hours a day may be a sign of excessive exercise. Limit vigorous exercise to 30- to 50-minute sessions per day to avoid stressing your cardiovascular system. One hour sessions are enough for weight training; going beyond that can bring on catabolism, which can cause muscle breakdown. Runners should keep it to no more than 10 to 15 miles per week to protect their hearts.

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Exercise is a stressor and the stresses of exercise have a catabolic effect on the body – contractile proteins within muscles are consumed for energy, carbohydrates and fats are similarly consumed and connective tissues are stressed and can form micro-tears. However, given adequate nutrition and sufficient rest to avoid overtraining, the body’s reaction to this stimulus is to adapt and replete tissues at a higher level than that existing before exercising. The results are all the training effects of regular exercise: increased muscular strength, endurance, bone density, and connective tissue toughness. Too much exercise can be harmful. The body parts exercised need at least a day of rest, which is why some health experts say one should exercise every other day or 3 times a week. Without proper rest, the chance of stroke or other circulation problems increases, and muscle tissue may develop slowly. It has also been noted by the medical field that expectant mothers should never exercise two days consecutively. Inappropriate exercise can do more harm than good, with the definition of “inappropriate” varying according to the individual. For many activities, especially running, there are significant injuries that occur with poorly regimented exercise schedules. In extreme instances, over-exercising induces serious performance loss. Unaccustomed overexertion of muscles leads to rhabdomyolysis (damage to muscle) most often seen in new army recruits. One sign of Overtraining Syndrome (OTS) is suppressed immune function, with an increased incidence of upper respiratory tract infection (URTI). An increased incidence of URTIs is also associated with high volume/intensity training, as well as with excessive exercise (EE), such as in a marathon.

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Seven Signs you may be overdoing it:

The article by personal trainer Jennipher Walters addresses signs of overtraining that are commonly overlooked or misdiagnosed. The following seven symptoms may signal that you need to cut back a bit and allow your body to recover between sessions:

1. Exercise leaves you exhausted instead of energized.

2. You get sick easily (or it takes forever to get over a cold)

3. You have the blues

4. You’re unable to sleep or you can’t seem to get enough sleep

5. You have ”heavy” legs

6. You have a short fuse

7. You’re regularly sore for days at a time

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Overtraining:

It is important to note the difference between overtraining and over-reaching; over-reaching is when an athlete is undergoing hard training but with adequate recovery, overtraining however, is when an athlete is undergoing hard training without the adequate recovery. Overtraining can lead to exercise addiction which can lead to negative physiological and psychological effects.

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Some Effects of Excessive Exercise:

•You are prone to injuries- When you exercise excessively your body is prone to injuries. Your body needs rest too. If you exercise a lot, then it leads to strained ligaments and tendons. This put your bones at the risk of fractures. Too much exercise can also harm your body tissues. So you need to exercise only so much, which your body can support.

•Muscle Mass- You tend to lose muscle mass and your body becomes nutrition deficient. You curb your body’s need of nutrition by excessive exercise and diet.

•Weakened Immune System- When you exercise a lot your body’s immune system weakens. You get more prone to viruses and colds. Exercise affects your body and leaves it exhausted. Your body pains and your weakened immune system are not efficient enough to kill bacteria or other illness.

•Cessation of Menstrual Cycle- Studies show that female athletes who face rigorous training experience Amenorrhea and if it persists for long, then it is difficult to cure. Other factors like changes in diet, excessive weight loss and stress can also cause amenorrhea.

•Eating Disorders- People who are exercise addicts and just have weight loss in mind, are prone to eating disorders. So, such people may face eating disorders like bulimia and anorexia can be caused due to exercise addiction.

•Sleeping Disorders- You face this problem because your body feels very tired, lethargic and drained out. Everything seems heightened and your body pains because of excessive exercise.

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Excessive exercise and heart damage:

Exercisers who train chronically to compete in marathons, triathlons, and other long-distance events may be hurting their heart health.  Chronic extreme endurance efforts, like marathons, ultra-marathons, and long-distance triathlons, can cause cardiovascular damage over time. Healthier exercise patterns involve not such extreme duration or intensity. Researchers found that running at moderate speeds was linked with a lower risk of death from any cause compared to no running. More intense running didn’t yield additional benefit. Evidence about the ill effects of chronic training for extreme endurance events is accumulating. An evolving body of data indicates that chronic training for, and participation in, extreme endurance events ”can cause dilation and stretching of the heart’s chambers, especially the atria and right ventricle”. The pumping ability of the right ventricle can be reduced. Blood indicators (biomarkers) that reflect damage to the heart muscle can increase. These changes usually return to normal within about a week. However, if the training is chronic, it may lead to scarring, enlargement, and stiffening of the heart. There is a risk, too, of developing abnormal heart rhythms such as atrial fibrillation. In a 2012 study in the European Heart Journal researchers compared 102 healthy male runners, aged 50 to 72, to 102 men who did not run. Each runner had done at least five marathons in the last three years. About 12% of the marathon runners had heart scarring. It was three times more common in them than in the comparison group. During a two-year follow-up, the marathoners were more likely to have a heart attack or other heart or stroke-related problem. Additionally, long-term excessive sustained exercise may be associated with coronary artery calcification, diastolic dysfunction, and large-artery wall stiffening. A 2011 German study revealed a very high incidence of carotid and peripheral atherosclerosis among male marathon runners. An autopsy released after the recent death of legendary long-distance runner Micah True found he had cardiomyopathy. In the condition, the heart becomes enlarged, thick, or rigid.

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Scientific studies showing heart damage due to excessive exercise:

1. A 2006 study screened 60 non-elite participants of the 2004 and 2005 Boston Marathons, using echocardiography and serum biomarkers. Researchers found decreased right ventricular systolic function in the runners, caused by an increase in inflammation and a decrease in blood flow.

2. A 2010 study presented by the American College of Cardiology showed that endurance runners have more calcified plaque in their arteries (which also increases stroke and dementia risk) than those who are not endurance athletes.

3. According to a study presented at the Canadian Cardiovascular Congress 2010 in Montreal, regular exercise reduces cardiovascular risk by a factor of two or three, but the extended vigorous exercise performed during a marathon raises your cardiac risk seven-fold!

4. In a 2011 study published in the Journal of Applied Physiology, researchers recruited a group of extremely fit older men, all members of the 100 Marathon club (having completed a minimum of 100 marathons). Half of the men showed heart muscle scarring as a result of their endurance running—specifically, the half who had trained the longest and hardest. If running marathons provided cardiovascular benefit, this group would have had the healthiest hearts!

5. A 2011 rat study published in the journal Circulation was designed to mimic the strenuous daily exercise load of serious marathoners over the course of 10 years. All the rats had normal, healthy hearts at the outset of the study, but by the end, most of them had developed “diffuse scarring and some structural changes, similar to the changes seen in the human endurance athletes.

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Excessive exercise causes oxidative stress:

Endurance exercise can increase oxygen utilization to over 10 to 20 times the resting state, and all this extra oxygen consumption then increases production of free radicals, which are produced as the oxygen is used to convert energy into ATP for muscle contractions. Oxidative stress from free radicals damages cellular proteins, membranes and genes and leads to a state of chronic, systemic inflammation. Chronic inflammation is implicated in diseases such as cancer, heart disease, strokes, Alzheimer’s, Parkinson’s and premature aging; the same diseases exercise is supposed to prevent.

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Excessive exercise causes hormonal imbalance:

The adrenal glands are two thumb-sized glands sitting atop your kidneys. They produce hormones like norepinephrine, cortisol and DHEA, which allow your body to respond and make adjustments to physical or emotional stress. If the intensity and frequency of the stress becomes too great, then the adrenal glands can begin to become exhausted, and the hormones that they produce can become depleted, resulting in serious imbalances that can cause issue like estrogen dominance in women or testosterone deficiencies in men. The end result is a tired, chronically fatigued individual who has disrupted sleep, low libido, worn-out looking eyes, a set and stressed jawline, and a “skinny fat” body look no matter how much exercise they do.

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Exercise addiction:

The upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5) include behavioral addictions. Although gambling will be the only designated behavioral addiction, this new diagnostic nomenclature will no doubt lead to increased research into all forms of excessive behavior, such as exercise, that have been considered to be addictive. This research will require a clear description of exercise addiction as distinct from a healthy habit. As with other behavioral addictions, it will also be necessary to distinguish exercise addiction from compulsions and impulse control disorders. An understanding of common co-occurring disorders will also be important to the extent that they mask exercise addiction and/or complicate treatment.

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Defining Exercise Addiction:

What distinguishes the everyday gym enthusiast from someone addicted to exercise?

Would we consider an elite athlete training for the Olympics as having an exercise addiction?
Hausenblas and Downs identify exercise addiction based on the following criteria:

•Tolerance: increasing the amount of exercise in order to feel the desired effect, be it a” buzz” or sense of accomplishment;

•Withdrawal: in the absence of exercise the person experiences negative effects such as anxiety, irritability, restlessness, and sleep problems;

•Lack of control: unsuccessful at attempts to reduce exercise level or cease exercising for a certain period of time;

•Intention effects: unable to stick to one’s intended routine as evidenced by exceeding the amount of time devoted to exercise or consistently going beyond the intended amount;

•Time: a great deal of time is spent preparing for, engaging in, and recovering from exercise;

•Reduction in other activities: as a direct result of exercise social, occupational, and/or recreational activities occur less often or are stopped;

•Continuance: continuing to exercise despite knowing that this activity is creating or exacerbating physical, psychological, and/or interpersonal problems.

Although others have defined exercise addiction using different models, the above definition is most closely aligned with the DSM-5 criteria for behavioral addiction which will be modelled after those for substance dependence. Based on a review of a wide range of studies on exercise addiction, Sussman, Lisha, and Griffiths estimate the prevalence in the general population to be close to 3%. Among certain groups such as ultra-marathon runners and sport science students the figure is even higher. According to Lejoyeux, Avril, Richoux, Embouazza, and Navoli, 42% of the members at a Parisian fitness club met criteria for exercise addiction.

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Five indicators of exercise addiction are:

1. An increase in exercise that may be labelled as detrimental, or becomes harmful.

2. A dependence on exercise in daily life to achieve a sense of euphoria; exercise may be increased as tolerance of the euphoric state increases.

3. Not participating in physical activity will cause dysfunction in one’s daily life.

4.Withdrawal symptoms following exercise deprivation including anxiety, restlessness, depression, guilt, tension, discomfort, loss of appetite, sleeplessness, and headaches.

5. High dependence on exercise causing individuals to exercise through trauma and medical conditions.

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There is a fine line between a healthy habit and an addictive obsession. The phrase ‘healthy obsession’ is really an oxymoron, since obsession is arguably a pathological disease state of the mind, therefore not healthy. Definitions for obsession range from compelling motivation to compulsive preoccupation. However you want to label it, obsession relates to an altered state of consciousness in which the need or compulsion to do a certain act overpowers all else, becoming a priority over all other needs and obligations in a person’s life. When exercise becomes the obsession, the risk of dependence is lurking nearby. You may have heard of the so called, ‘runner’s high,’ which presents as a euphoria from the natural opioid-like chemicals, endorphins, released in the brain during exercise. Another theory proposed to explain the euphoric mechanism has to do with catecholamine release, which directly controls mood, attention, movement, and the body’s endocrine/cardiovascular responses to stress. Key differences between healthy and addictive levels of exercise include the presence of withdrawal symptoms when exercise is stopped as well as the addictive properties exercise may have leading to a dependence on exercise.

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According to Modolo et al., compulsive athletes report four components of addiction:

1) feeling euphoria,

2) the need to increase the dose of exercise to obtain feelings of well-being (tolerance),

3) difficulties in the performance of professional or social activities (rearrangement of priorities) and

4) symptoms of the absence or need, including depression, irritability, and anxiety, when unable to engage in the activity (withdrawal).

This 2011 study also found a direct relationship between the intensity of exercise and the severity of withdrawal symptoms. The time spent preparing for, engaging in, and recovering from workouts and the continuance despite exacerbating physical, psychological, and/or interpersonal problems are two more signs that a healthy habit has turned into a neurotic addiction. More negative characteristics include low self-esteem, the use of exercise as management or manipulation of psychological states, increasing body dissatisfaction, and chronic vulnerability to overtraining injuries. The physical manifestations of exercise dependence have been most documented in distance runners; persistent soft tissue injuries (sprains and strains), stress fractures, pressure sores, gastrointestinal blood loss and iron-deficiency anemia just name a few. From a genetic standpoint, asymmetry in the brain has been correlated to negative emotions. One study in particular found a relationship between frontal lobe brain asymmetry and exercise addiction, implying that exercise directly activates and alters the part of the frontal lobe responsible for affect and mood, thereby improving negative emotions. There are often feelings of guilt associated with the absence of or inability to exercise for even one day, and dieting to improve performance is common. It should be noted that there is a strong risk and link between eating disorders and excessive exercise, since it is often the primary means of weight loss. It is important to distinguish one from the other, usually by analyzing the motive for exercise and other associated symptoms that may point toward the diagnosis of an eating disorder.

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Causes of exercise addiction:

Exercise addiction is thought to be related to the euphoric feelings resulting from the rapid release of endorphins that occurs during intense bouts of exercise. Although the evidence is not conclusive, there is a high correlation between exercise addiction and endorphins. Endorphins work by activating opiate receptors in the brain causing pain relief and are also correlated with causing euphoric feelings. The decrease of pain and increase in euphoric feelings creates a positive feedback loop associated with exercise which is thought to be a cause of addiction. This feedback loop also helps to explain why intensity of exercise increases over time with exercise addiction. For individuals who exercise more frequently the effects of endorphins are decreased. A person with an exercise addiction will need to increase the frequency, intensity, and/or time of exercising to reach the desired euphoric feelings. Biological studies show that in rodents, exercise such as wheel running activates the dopamine reward system and thus contributing to stress reduction. Further evidence suggests that running is associated with endorphins and cannabinoids thus explaining the “runners high” or euphoric feelings that may lead to exercise addiction. Genetic studies suggest that genes which control preference for drugs also control the preference for naturally rewarding behaviors such as exercise. Psychological studies also explain exercise addiction in terms of reward, habituation, social support, stress-relief, avoidance of withdrawal and reduction of anxiety.

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Treatment of exercise addiction:

Treatment for exercise addictions and activity disorders is often similar to that for men and women with eating disorders, especially if they coexist. Depending on the other issues at hand, it may require an inpatient treatment program and medical attention. Therapists and counsellors can work on the person on his or her underlying issues and help with the achieving of peace of mind and body. When it comes to treating this addiction, abstinence from exercise may not be the required goal. Because exercise in moderation is considered a healthy habit, a typical treatment goal will be to return to moderate exercise. In some cases, a new form of exercise may be recommended; the runner becomes a swimmer. In other cases the person may continue to do the same form of exercise in a more controlled or moderate manner. Whether moderating the original exercise behavior or replacing one activity with another, clinicians can use the attributes of the four phases of addiction as a way to help patients distinguish problematic or addictive exercise from moderate or recreational exercise.

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Now let me discuss few ground breaking studies:

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Lack of exercise is a global pandemic, according to The Lancet: 2012:

According to a recent study published in The Lancet, lack of exercise has become a global pandemic, causing nearly a tenth of all deaths worldwide. What is most alarming about the study is that lack of exercise is killing roughly the same number of humans as smoking. The new research covered 122 nations representing 89% of the world’s population. About 5.3 million of the 57 million deaths worldwide in 2008 could be attributed to inactivity, the new report estimates, largely due to four major diseases: heart disease, Type 2 diabetes, breast cancer and colon cancer. The study finds that if physical inactivity could be reduced by just 10%, it could avert some 533,000 deaths a year; if reduced by 25%, 1.3 million deaths could be prevented. Say we got everyone off the couch and eliminated inactivity altogether: the life expectancy of the world’s population would rise by about 0.68 years (more, if you discount those who were already active), comparable to the effect of doing away with smoking or obesity. Though nearly 3 out of 4 countries that are members of the World Health Organization have national plans to tackle inactivity, only 42% of those plans are funded and operational, another Lancet study found.

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Lack of Exercise more deadly than Obesity: a 2015 study:

Being sedentary may be twice as deadly as being obese, a new study suggests. However, even a little exercise — a brisk 20-minute walk each day, for example — is enough to reduce the risk of an early death by as much as 30 percent. Efforts to encourage small increases in physical activity in inactive individuals likely have significant health benefits. The risk reduction was seen in normal weight, overweight and obese people. Authors estimated that eradicating physical inactivity in the population would reduce the number of deaths twice as much as if obesity was eradicated. The message from this study is clear and simple — for any given body weight, going from inactive to active can substantially reduce the risk of premature death. For the study, researchers collected data from 334,000 men and women. Over an average of 12 years of follow-up, they measured height, weight, waist circumference and self-reported levels of physical activity. They found that a moderate amount of physical activity, compared with no activity, was the key to lowering the chances of premature death. The researchers estimated that exercise that burns between 90 and 110 calories a day could reduce the risk of an early death by between 16 percent and 30 percent. The effect of moderate exercise was greatest among normal weight people, but even overweight and obese people saw a benefit. Using the most recent data on deaths in Europe, the team estimated that 337,000 of the 9.2 million deaths of European men and women were linked to obesity. However, twice that number of deaths could be connected to lack of exercise. Aerobic exercise ignites the body’s immune system, improves mental function, boosts energy, strengthens muscles and bones, and reduces the risk for chronic diseases such as heart disease, cancer and diabetes.

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Sitting or Standing? Makes Zero difference without Exercise: 2015 study:

Researchers at the University of Exeter and University College London studied 16 years’ worth of health data from 5,132 people. The results showed that the total amount of time spent sitting (including sitting at work, at home, during leisure time) was not linked with the risk of all-cause mortality. Researchers also tracked time spent walking daily and on physical activity. Their findings suggest that reducing sitting time might not be quite as important for mortality risk as previously publicized and that encouraging people to be more active should still be a public health priority. 450 participants died during the course of the study, but the researchers found that overall sitting time didn’t correlate with a higher incidence of death, even after they controlled for age, gender, diet, general health and socio-economic status. They stressed on the importance of physical activity more than avoiding sitting for long periods. Spending long hours sitting is painted as an extremely unhealthy habit that is associated with a number of diseases. An expert statement released in the British Journal of Sports Medicine recommended Americans stand, move and take breaks for two hours out of an eight-hour work day. So are standing desks a solution? No, according to this study. New findings now suggest that sitting is not detrimental to one’s health if one indulges in physical exercise. It’s the sedentary lifestyle itself that kills, not the nice comfy chair. This also means that it’s pretty pointless for us to be standing at our desks at work since we’ll still be at equal risk of dying anyway.

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Contrary study: prolonged sitting wipes out health benefits of recommended exercise:

Active couch potato effects:

An active couch potato refers to someone who is inactive for the majority of the day, but regularly makes sure to get in 30 minutes of moderate intensity exercise on most days. In a 2012 study published in the International Journal of Behavioral Nutrition and Physical Activity, researchers reported that people spent an average of 64 hours a week sitting, 28 hours standing, and 11 hours milling about (nonexercise walking), whether or not they exercised the recommended 150 minutes a week. That’s more than nine hours a day of sitting, no matter how active they otherwise were. Unless you have a job that keeps you moving, most of your nonrunning time is likely spent sitting. And that would make you an “active couch potato”—a term coined by Australian researcher Genevieve Healy, Ph.D., of the University of Queensland to describe exercisers who sit most of their day. If they aren’t careful, she says, active couch potatoes face the same health risks as their completely inactive counterparts. Up until very recently, if you exercised for 30 minutes or more a day, you were considered physically active. Now a consistent body of emerging research suggests it is entirely possible to meet current physical activity guidelines while still being incredibly sedentary, and that sitting increases your risk of death and disease, even if you are getting plenty of physical activity. Perhaps most potentially disconcerting about the health risks of sitting is that exercise does not appear to be enough to counteract its negative effects.

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Your body is designed to move. Sitting for an extended period of time causes your body to shut down at the metabolic level. When your muscles, especially certain leg muscles, are immobile, your circulation slows. So you use less of your blood sugar and you burn less fat, which increases your risk of heart disease and diabetes. Indeed, a study of 3,757 women found that for every two hours they sat in a given work day, their risk for developing diabetes went up seven percent, which means their risk is 56 percent higher on days they sit for eight hours. And a study published in the American Journal of Epidemiology reports that a man who sits more than six hours a day has an 18 percent increased risk of dying from heart disease and a 7.8 percent increased chance of dying from diabetes compared with someone who sits for three hours or less a day. Although running does much good for you, if you spend the rest of your waking hours sitting, those health benefits depreciate. In a 12-year study of more than 17,000 Canadians, researchers found that the more time people spent sitting, the earlier they died—regardless of age, body weight, or how much they exercised. Adding to the mounting evidence, researchers recently discovered that a key gene (called lipid phosphate phosphatase-1 or LPP1) that helps prevent blood clotting and inflammation to keep your cardiovascular system healthy is significantly suppressed when you sit for a few hours. The shocker was that LPP1 was not impacted by exercise if the muscles were inactive most of the days. Heart disease and diabetes aren’t the only health hazards active couch potatoes face. The American Institute for Cancer Research now links prolonged sitting with increased risk of both breast and colon cancers. Sitting time is emerging as a strong candidate for being a cancer risk factor in its own right. Emerging evidence suggests that the longer you sit, the higher your risk. It also seems that exercising won’t compensate for too much sitting. Interrupting your sedentary time as often as possible and making frequent posture changes is important.

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The Importance of Non-Exercise Movement:

If you think about it, why do we exercise? We exercise because we’re trying to replicate what our ancestors did. They moved around to a far greater degree than we do today, largely because they did not have the major technology we do today to easily obtain our food and shelter. Our ancestors didn’t have to exercise per se because they rarely sat down. They moved all day long, and research shows this is absolutely key for health. In fact, studies show that engaging in consistent exercise does not counteract the adverse cardiovascular and metabolic effects of prolonged sitting.  So non-exercise movement is now recognized as being a foundational piece for optimal health — even more so than exercising for an hour a few times a week. Ideally, you’d do them both, but if you’re currently sedentary, start by sitting less.

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Are exercise recommendations too much?

That looming 150-minute figure seems like nobody has time for that. This is the problem with our exercise recommendations, argues a new analysis published in The BMJ. They’re just set far too high to motivate the people who need them the most. That’s the argument of Philipe de Souto Barreto, a researcher at University Hospital of Toulouse in France and author of the new paper. “Getting inactive people to do a little bit of physical activity, even if they don’t meet the recommendations, might provide greater population health gains,” he writes. It’s not that the recommendations are off for optimal health. 150 minutes of moderate physical activity each week, which the World Health Organization sets as its target, is a great goal that’s been shown to reduce risk for all kinds of diseases and death, Barreto says. But other data shows that gentler goals can also provide important health benefits. One study of more than 250,000 older adults found that getting less than an hour of moderate physical activity each week was linked to a 15% drop in death. Barreto also cites a review of 254 articles looking at the link between exercise and disease reduction, which found that the relationship between the two is dose-dependent. In other words, it’s not an all or nothing affair: even minor shifts can help people who don’t get enough exercise. Another analysis of studies found that when people walk just 74 minutes a week, they have a 19% reduced risk of death, compared to the most sedentary people. Achieving target physical activity recommendations should remain as a goal but not the core public health message surrounding physical activity,” Barreto writes.

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My logic:

The figure above shows that only regular exercise with daily life physical activity (Non-Exercise Movement) confers health benefits.

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Not everyone benefits equally from exercise:

It does seem clear that older adults benefit more from exercise than younger people, as far as cognitive function is concerned. It also seems that older women, especially those on hormone-replacement therapy, receive greater cognitive benefits from exercise than men. Generalisations aside, it is as well to remember the findings of a very recent study showing that, while most people benefit (physically) from exercise, the degree of benefit is hugely variable between individuals, and some people don’t benefit at all! People mature at different rates, and there seems to be a genetic component to coordination, strength, speed, and one’s response to exercise. Nonetheless, everyone should strive to be as fit as they possibly can, given their strengths and limitations.

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Conventional wisdom has it that anyone who really wants to become fit can do so. Just walk or ride a bicycle, swim or run. Speed and endurance will improve and what was once hard will become easy. Lift weights, work with a trainer in a gym, and muscles will grow larger and stronger.  But when a few intrepid scientists began asking if those beliefs were true, they found that fitness, like weight loss, has genetic underpinnings, making it inherently much easier for some to get fit than it is for others.

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Three examples prove the role of genes in exercise benefits and physical fitness:

Example 1:

A measurement of a training response is the increase in the amount of oxygen people use when they try to push themselves hard. The more oxygen taken in, the more that enters the blood and is delivered to muscles and so the more intensely the person can exercise, running faster for example. The average increase after training was 400 milliliters of oxygen. But some people had no increase and in some the increase was more than double the average. The range was zero milliliters to 1,000 milliliters. The standard deviation was 200, meaning that two-thirds of the people increased their oxygen consumption by 200 to 600 milliliters of oxygen. These are huge differences, but within families, you have aggregation. Children tend to respond the way their parents do. Siblings tend to respond like each other. The heritability of responsiveness to exercise training was at least as great as it is for body weight, blood pressure and cholesterol.

Example 2:

The study, with Dr. Eric Hoffman, a geneticist at the Children’s National Medical Center in Washington and others, involves 700 men and 700 women who had not previously lifted weights and who agreed to train in a laboratory. They are trying to build the biceps and triceps muscles of one arm only. The other arm serves as a control while the researchers look for genetic variants that can explain their responses to training. Although muscle strength and size seem to go together, Dr. Hoffman says they are independent — some people can gain muscle size but not much strength; others can gain strength but not much size. Some gain both. Others gain neither.

Example 3:

Dr. Claude Bouchard, who now directs the Pennington Biomedical Research Center at Louisiana State University, did the studies with pairs of identical twins, finding that if one twin responded well to training, so did the other; if one did not respond, neither did the other.

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Some exercise physiologists and sports trainers had assumed that people who said they exercised but never increased their fitness were cheating, either dissembling about the amount of exercise they did or deceiving themselves about how hard they worked when they exercised. But it was not true. Now, having garnered convincing evidence that genes determine a person’s abilities at athletic training, scientists are conducting large and rigorous studies to track down the particular genes, and genetic variants, involved. The studies do not address the effects of exercise on overall health, whether it helps ward off heart disease or brings longer life, but they are intent on determining the answers to certain health-related questions. For instance, the new research may help find better ways of preventing old people from falling because their muscles are weak.  Is there a way of deciding who needs extra help in maintaining muscle strength or is there an ideal way of augmenting strength in people who are genetically predisposed to be weak? Can an understanding of the genetic variants that control how large and how strong muscles grow lead to better treatments?  But the research is detecting measures of athletic fitness and, as a consequence, the studies raise ethical questions. Should people be told if they have a gene that will prevent them from ever getting aerobically fit? Should coaches be able to do genetic testing of athletes to learn who is most likely to improve, and who has the genes to be a future star?

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Exercise as medicine:

Did you know that exercise is one of the safest, most effective ways to prevent and treat chronic diseases such as heart disease?

This common-sense advice was again confirmed in a meta-review conducted by researchers at Harvard University and Stanford University, which compared the effectiveness of exercise versus drug interventions on mortality outcomes for four common conditions:

•Diabetes

•Coronary heart disease

•Heart failure

•Stroke

After reviewing 305 randomized controlled trials, which included nearly 339,300 people, they found “no statistically detectable differences” between physical activity and medications for prediabetes and heart disease.  Exercise was also found to be more effective than drugs after you’ve had a stroke. The only time drugs beat exercise was for the recovery from heart failure, in which case diuretic medicines produced a better outcome.

The drugs assessed in the studies included:

•Statins and beta blockers for coronary heart disease

•Diuretics and beta blockers for heart failure

•Anticoagulants and antiplatelets for stroke

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The featured review is a potent reminder of the power of simple lifestyle changes, as well as the shortcomings of the drug paradigm. If you’re interested in living a longer, healthier life, nothing will beat proper diet and exercise. Exercise is in fact so potent, the researchers suggested that drug companies ought to be required to include it for comparison when conducting clinical trials for new drugs! The analysis adds to evidence showing the benefit of non-medical approaches to disease through behavior and lifestyle changes.  In cases where drug options provide only modest benefit, patients deserve to understand the relative impact that physical activity might have on their condition. Exercise interventions should therefore be considered as a viable alternative to, or, alongside, drug therapy.

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Exercise prescription:

Exercise prescription commonly refers to the specific plan of fitness-related activities that are designed for a specified purpose, which is often developed by a fitness or rehabilitation specialist for the client or patient. Due to the specific and unique needs and interests of the client/patient, the goal of exercise prescription should be focus on motivation and customization, thus making achieving goals more likely to become successful.  In the United Kingdom there is a scheme called “Exercise on prescription” in which doctors are able to prescribe exercise to those with conditions that benefit from it, such as asthma, depression or obesity. The initiative particularly aimed to lower the rate of heart disease. Researchers in New Zealand have also discussed the benefits of exercise referral by medical practitioners there. In New Zealand it is known as a green prescription, while in the United States a similar initiative is known as Exercise is Medicine.

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The thinking in today’s society is that exercise is a tool to cure. If physical activity is considered normal and necessary for good health, the notion that physical inactivity is a cause of chronic diseases will be easy to support. Healthcare professionals play an important role in promoting physical activity and weight management. Primary care starts with primary prevention. General practitioners have access to a large proportion of patients with co-morbidities, obesity and sedentary lifestyles and are a respected source of advice. Prescribing exercise as prevention should be a responsibility of primary care providers.

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Physical therapy:

Physical therapy or physiotherapy (often abbreviated to PT) is a physical medicine and rehabilitation specialty that remediates impairments and promotes mobility, function, and quality of life through examination, diagnosis, prognosis, and physical intervention (therapy using mechanical force and movements). It is carried out by physical therapists (known as physiotherapists in most countries). PT management commonly includes prescription of or assistance with specific exercises, manual therapy and manipulation, mechanical devices such as traction, education, physical agents which includes heat, cold, electricity, sound waves, radiation, rays, prescription of assistive devices, prostheses, orthoses and other interventions.

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Role of family physicians in promoting physical activity in society:

Among the many reasons for low levels of activity among population is the missed opportunity for family physicians to influence their patients’ exercise behaviour. Although family physicians are well positioned to counsel patients about exercise, studies show that rates of such counselling remain low. When it comes to things that get in the way of physicians providing exercise advice to their patients, the usual suspects come into play—lack of time, lack of financial reimbursement, and lack of training. One of the best predictors of whether a physician provides exercise counselling to patients, however, is the physician’s own level of physical activity. One of the earliest studies to show this was the US Women Physicians’ Health Study, which determined that women doctors who complied with the ACSM-AHA physical activity recommendations were much more likely to counsel patients to exercise and to be trained in such counselling.  Subsequent further work by Frank and colleagues has shown clearly that “active doctors prescribe activity.”  These researchers have also indicated that talking to your patients about your own exercise habits can make your advice more credible and can help motivate them to become more active. Doctors are unique in being trusted, often seeing people at their most vulnerable and interacting with many of those suffering the worst health, in particular those with the most to gain from small improvements in health. Since such a large proportion of the population are inactive or moderately inactive, even small differences in lifestyle may make a big difference to health in the population and encourage behaviour change. Rates of exercise counselling by doctors remain low; only 34% of US adults report exercise counselling at their last medical visit. In view of this gap, one of the US health objectives is increasing the proportion of patients appropriately counselled about health behaviours, including exercise.

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What should doctors be saying to their patients?

The message is simple:

All adults should do physical activity at a minimum amount of 5-times-a-week, for 30 minutes each time. The sessions can be broken into 10- or 15-minute blocks. The activity should have moderate intensity – enough to get a little out of breath, and/or to feel your heart rate increase, and/or to feel a little sweaty. For children, a minimum of one hour exercise is expected, five times a week.

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The moral of the story:

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1. We would expect captive elephants to live at least as long, if not longer, than those in the wild because they are better cared for, but that is not the case. A study found that captive elephants in Zoo lived for 16-18 years while wild for 56 years. This is because wild elephants can roam over 300 to 2000 miles per day. Regular exercise is important to avoid illness and encourage normal behaviour patterns in most pet animals.  If physical inactivity reduces life span of elephant by third, what about humans?

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2. Physical activity means voluntary movement of large skeletal muscles requiring energy more than resting energy expenditure, often done to sustain daily living or recreation, and often provide health benefits. Activities that involve small skeletal muscles (e.g. writing) are not classified as physical activity as they hardly provide any health benefit. Exercise is a subcategory of physical activity that is planned, structured, repetitive, and purposeful, usually performed at free time with the goal to improve or maintain physical fitness. A “workout” is a term that refers to the period of time spent exercising — the exercise event. That makes “working out” the same thing as “exercise.” Physical inactivity means physical activity levels less than that required for optimal health and prevention of premature death.

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3. Physical fitness is a measure of the body’s ability to function efficiently and effectively in work and leisure activities without undue fatigue, resist diseases from sedentary lifestyles, and to meet emergency situations. In other words, physical fitness enables us to perform moderate-to-vigorous levels of physical activity without undue fatigue.

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4. Our ancestors had to go long distances every day in order to survive. Not exercising was never an option. So there was evolutionary selection pressure to avoid needless exercise to save energy. For example, when you walk into a train station and there is a staircase and an escalator, your brain always tells you to take the escalator due to very deeply rooted evolutionary instinct. Nowadays due physical inactivity and overeating, this trait has become maladaptive. That is why we have to make conscious effort to exercise through some form of socially acceptable coercion.

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5. Aerobic exercise means large skeletal muscles performing exercise utilize oxygen to generate energy for exercise so that all glucose/fatty acid is aerobically turned into energy and muscle cells can contract repeatedly without fatigue. Cardio is aerobic exercise performed at moderate levels of intensity for extended periods of time. Intensity is the rate of energy expenditure of exercise correlating with the efforts to perform exercise. This moderate intensity can vary from 60 to 80% of maximum heart rate, 40 to 60 % of VO2 max and 3 to 5.9 MET. For cardiovascular health benefits, at least 30 minutes of moderate intensity aerobic exercise should be performed on most days per week. Aerobic exercise of fewer than 2 days per week, at less than 40 % of VO2 max, and for less than 10 min duration is generally not sufficient to confer cardiovascular health benefit. Anaerobic exercise does not utilize oxygen to generate energy for exercise and generate lactate from anaerobic glycolysis. The muscles are exercised at high intensity for short durations.  Resistance training not only builds muscle and bone density, it reduces body fat and even improves your cardiovascular health. Simply put, aerobic exercise is a low to moderate intensity activity sustained for a long duration, while anaerobic is a high intensity exercise done for a short duration. In reality, the more intensely we exercise, the greater the need for anaerobic energy production.  Consequently, it is best to view the terms aerobic and anaerobic as transitions in metabolism, where the proportion between aerobic and anaerobic metabolism changes depending on exercise intensity.  All aerobic exercises like running, cycling and rowing, effectively become anaerobic when performed in excess of 90% maximum heart rate. In almost all conditions, anaerobic exercise is accompanied by aerobic exercises because the less efficient anaerobic metabolism must supplement the aerobic system due to energy demands that exceed the aerobic system’s capacity.

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6. Maximum effort exercise is when exerciser makes so much efforts that he/she utilizes full VO2 max achieving maximum heart rate (i.e. 220 minus age). Over-exercise (excessive exercise) is when person exercises for more than 2 hours continuously, the only exception being highly trained athlete e.g. highly trained marathon runner.

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7. Metabolic Equivalent of Task (MET) is the ratio of the work metabolic rate to the resting metabolic rate. One MET is 1 kcal/kg/hour (0.0166 kcal/kg/min) energy expenditure utilizing 3.5 ml/kg/min oxygen; equivalent to the energy cost and the oxygen use of sitting quietly. MET values of activities range from 0.9 (sleeping) to 2 (walking at a slow pace 3 km/h) to 3.3 (brisk walking at 3 miles/hr) to over 6 (running).

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8. VO2 max is the maximum rate of oxygen consumption during the aerobic catabolism of glucose/fatty acid measured during incremental exercise, most typically on a motorized treadmill. Maximal oxygen uptake (VO2 max) is widely accepted as the single best measure of cardiovascular fitness and maximal aerobic power. Absolute values of VO2 max are typically 40-60% higher in men than in women. The average untrained healthy male will have a VO2 max of approximately 35 – 40 mL/kg/min. Highly trained male athletes can consume up to 85 mL/kg/min.

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9. While doing maximum effort exercise, an average person uses oxygen 10 times that of rest and highly trained athlete doing the same exercise uses oxygen half of that of average person as intensity of the same exercise will be lower in highly trained athlete. In other words, maximum effort exercise performed by highly trained athlete is of double intensity than maximum effort exercise performed by average man.

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10. Over half of the world population are physically inactive, that is, not performing the minimum recommended 30 minutes of moderate-intensity activity on at least 5 days of the week. Screen time is the time spent watching television, computers, video games and smartphones making you inactive and taking away your time for exercise.

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11. About 50% of people who start an exercise program will drop out during the first 6 months due to low levels of motivation & self-efficacy, time-shortage, low familiarity with exercise, poor social & cultural support, and the belief that exercise will not bring any benefit.

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12. You don’t have to be athletic to exercise. A perfect example is brisk walking.

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13. No one is too young or too old to exercise.

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14. Household work cannot be counted as exercise as people who say they exercise by doing housework are overestimating the intensity or the duration of the activity.

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15. Health benefits of physical activity depend mainly on total weekly energy expenditure due to physical activity rather than any one component (frequency, intensity, or duration). The minimum optimal “volume” (frequency, duration and intensity of exercise) of exercise that confers health benefits is exercise that uses energy worth 500 to 1,000 MET-minutes per week. Most experts and professionals advocate a minimum volume of exercise that expends 1000 kcal (4200 kJ) per week for health benefits. For a 70 kg individual, 1000 kcal per week comes to 860 MET-minutes. The target could be lower for elderly.  However, it is not all or none phenomenon as relationship between exercise and disease reduction is dose dependent, and even micro-workout of 7 minutes is helpful. Some exercise is better than none; more exercise is better than some; and exercise in greater variety is better than uniform exercise. The combination of aerobic exercise with resistance training and flexibility exercises would render greater health benefits and better quality of life. The largest health gains occur in people moving from inactivity to activity.

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16. Although exercise affects gene’s behaviour by epigenetic alteration resulting in preventing and/or confronting various disorders, such as metabolic or neurodegenerative diseases, obesity, diabetes mellitus, cardiovascular disease and cancer; it is your genes that determine how you respond to exercise in getting exercise benefits and fitness. Therefore not everyone benefits equally from exercise.

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17. Aerobic exercise improves cardio-respiratory system by improving their efficiency and capacity. Skeletal muscles contractions improve muscle mass; with resultant pull over bones and weight bearing improve bone density. Exercise improves insulin sensitivity, reduces obesity, reduces LDL and reduces blood pressure & heart rate. Although acute exercise increases heart rate & blood pressure transiently due to stimulation of sympathetic nervous system, chronic regular aerobic exercises leads to aerobic conditioning (training) which decreases heart rate at rest and during exercise, and also decreases blood pressure due to improved stroke volume, reduced peripheral resistance, decreased sympathetic activity and increased vagal tone.

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18. Exercise improves blood flow to brain, promotes neuronal growth and triggers neurotransmitters such as endorphins, norepinephrine, serotonin, dopamine, glutamate, and GABA. Routine physical activity is also associated with improved psychological well-being through reduced stress, anxiety and depression. Exercise can be a healthy, safe and inexpensive way to achieve more and better sleep. Exercise acts as a type of distraction, biofeedback, meditation, or psychological buffer and can result in an increased sense of self-efficacy, control, and mastery.

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19. Exercise in elderly reduces risk of cardiovascular disease, osteoarthritis, osteoporosis, hypertension, diabetes and falls. It also improves cognition, maintains their independence and contributes to the management of depression and anxiety. Taken together, these benefits can significantly improve quality and quantity of life in elderly populations. When elderly cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

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20. Physically active children are better off cognitively, emotionally and socially. For school going children, time spent in physical activity programmes does not hinder academic performance, and it may indeed improve academic performance.

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21. People who exercise regularly yet have other risk factors for cardiovascular disease may be at lower risk of premature death than people who are sedentary with no risk factors for cardiovascular disease.

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22. For a long time, rest and physical inactivity had been recommended for patients with heart failure. Numerous trials have now demonstrated that moderate exercise in patients with heart failure appear to be safe; and in fact improves cardiac output at maximal workloads, improves mitochondrial size and density in cardiac muscle, reduces endothelial dysfunction, and decreases circulating catecholamine.

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23. Although moderate aerobic exercise is now strongly recommended as part of the lifestyle modifications as an adjunct to pharmacological therapy for treatment of hypertension, people with moderate to severe hypertension must reduce blood pressure by pharmacological therapy before starting exercise regimen.

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24. Exercise with diet control is better than metformin to prevent diabetes mellitus. Also in diabetics, exercise reduces A1c level by 0.5 to 1 % and reduces mortality risk.

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25. Largest driver behind obesity is not how sedentary people are but how unhealthy their diet is (i.e. fast food plus junk food), and people only lose noticeable weight if they combine exercise and calorie restriction. In my view, to reduce weight in obese individual, dietary restriction contribute 80 % and exercise contribute 20 %; although exercise does reduce risk of cardiovascular disease and all-cause mortality among more active individuals regardless of weight loss. Being sedentary may be twice as deadly as being obese. In other words, physically fit obese individual exercising regularly is healthier than a sedentary normal weight individual.

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26. To reduce belly fat, first you have to address your diet, and then do exercise to reduce weight, and then do exercise that target your abdominal muscles.

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27. Walking and swimming are two activities that are considered safe throughout pregnancy. Moderate exercise during pregnancy decreases risk of pre-eclampsia and gestational diabetes in mother. However, vigorous exercise in pregnancy is associated with miscarriage and small birth weight babies.

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28. Exercise confers economic benefits by reducing absenteeism, increasing productively & efficiency at work, and reducing health expenditures of many non-communicable diseases (NCD).  Lack of fitness in the society has a severe negative economic impact.

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29. Physical inactivity has been identified as the fourth leading risk factor for global mortality and this risk may decrease by 19 % with as little as 30 minutes of moderate-intensity physical activity per day five days a week in people who are physically inactive. Recommended moderate exercise extends life expectancy to as much as 4 to 5 years. A middle-aged person who gets the recommended 150 minutes per week of moderate exercise can expect a 1-to-7 return: seven extra minutes of life gained for each minute spent exercising.

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30. The global epidemic of physical inactivity is labelled as ‘the new smoking’ because lack of exercise is killing roughly the same number of humans as smoking. About 5.3 million of the 57 million deaths worldwide in 2008 could be attributed to inactivity while more than 5 million of deaths are the result of direct tobacco use.

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31. Inactive individual may have a maximal aerobic power of only six times their resting metabolic rate while person who exercises regularly will have a maximal aerobic power 10 to 12 times resting. A person cannot work throughout the day at much more than about 20 percent of maximal capacity without becoming chronically fatigued. An inactive person who has a maximal aerobic power of six times resting can comfortably sustain a work level of only about 1.2 times resting throughout the day (6 × 0.20 = 1.2). This low capability for sustained energy expenditure can support only a very sedentary existence. So inactiveness leads to sedentary life style and not vice versa. On the other hand, person who exercises regularly can comfortably sustain a work level of about 2.4 times resting throughout the day (12 × 0.20 = 2.4) and thereby leads active life easily. In other words, whether to lead sedentary or active life depends on your voluntary exercise behaviour, and not on your job, lack of time, socioeconomic factor or culture.

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32. Family physicians are well positioned to counsel patients about exercise; studies show that rates of such counselling remain low due to lack of time, lack of financial reimbursement, lack of training, and more importantly lack of exercise by physicians themselves. Active doctors prescribe activity. Inactive doctors do not prescribe activity. Similarly, those doctors who smoke tobacco or drink alcohol are unlikely counsel their patients to quit smoking or drinking.

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33. Exercise is equivalent to medicine in prevention and treatment of non-communicable diseases and exercise ought to be included for comparison when conducting clinical trials for new drugs. Exercise prescription should be given by doctors to prescribe exercise to those with conditions that benefit from it such as diabetes, hypertension, obesity, coronary artery disease, heart failure, stroke, osteoporosis, pulmonary diseases, cancer, dementia, depression and elderly.

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34. Active couch potato refers to someone who is inactive (sitting) for the majority of the day, but regularly makes sure to get in 30 minutes of moderate intensity exercise on most days. Prolonged sitting increases risk of heart disease, diabetes and some cancers despite getting recommended daily exercise. Exercising won’t compensate for too much sitting. You have to interrupt sitting by walking out of your chair frequently. Remember, regular exercise with daily life physical activity (Non-Exercise Movement)  confers health benefits. Regular exercise with sitting whole day does not confer health benefits.

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35. Once exercise becomes too much, the benefits are reduced, or even reversed, and it becomes a chronic stressor that reduces overall wellness. Those who exercised moderately lives the longest and are the healthiest compared to inactive (no exercise) or hyperactive (too much exercise).

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36. Walking is free, simple, enjoyable, low impact (does not put stress on the joints), weight-bearing (it can improve bone density) and already a part of everyday life. Nearly everyone can do it, no matter their age or physical condition. It requires no equipment. All you need to do is correct your technique, walk faster (about 100 steps per minute i.e. 3 miles per hr) and for longer time. This is brisk walking, 3.3 MET moderate intensity aerobic exercise, and 150 minutes of brisk walking per week is 500 MET-minute exercise conferring significant cardiovascular benefits. A brisk 20-minute walk each day is enough to reduce the risk of an early death by as much as 30 percent. Walking gives more health benefits than running provided energy expenditure of both are same (walk longer than you’d have to run); and walking stresses joints & cartilages of legs considerably less than running.  Running at moderate speeds is linked with a lower risk of death from any cause compared to no running. However more intense running didn’t yield additional benefit. In fact chronic extreme running efforts like marathons, ultra-marathons, and long-distance triathlons do cause cardiovascular damage over time. My exercise prescription to everybody is brisk walking at least 150 minutes per week.

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Dr. Rajiv Desai. MD.

November 19, 2015

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Postscript:

I am surprized to know that so many studies found exercise improving brain power by improving cognition & memory resulting in improved academic performance in children and college students, and preserving cognitive function in old age. Only one study of 2015 found that exercise may not help brain. When I look at my own life, I hardly exercised since childhood. Yet my cognition, memory, academic performance and creativity are above average. There are many examples of people with both interest in exercise and exceptional intelligence, but little if any evidence of a causal relationship in those cases. For example, Albert Einstein frequently commented that a large number of his theories were conceived while riding his bicycle. Outstanding intellectual achievement seems to be a result of different kinds of factors in different people.  It doesn’t appear that holding all other things equal and exercising heavily would lead someone to gain exceptional intellectual ability. Top athletes do possess the ability to process and react to complex and rapidly changing visual cues but that is not cognition. Physical exercise improving physical health is logical, physical exercise increasing brain volume in areas related to movement is plausible, but physical exercise improving intellectual ability is weird. In my view, most claims regarding exercise and the brain concern the neuroprotective effect of exercise rather than cognitive enhancement per se.

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Footnote 1:

If you’re interested in living a longer, healthier life, nothing will beat proper diet, moderate exercise, maintaining ideal body weight, with no tobacco and no alcohol. Not a difficult task but believe me, very few can do it.

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Footnote 2:

Advice to common man regarding exercise:

Take time to warm up and stay hydrated. You need to be sweating a bit and get short of breath. Keep it up for 15-20 minutes a day and you’re done! Never exercise when you are tired. Exercise without rest does not work. You should not be fatigued and/or dehydrated before exercise, during exercise and after exercise.

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Novel Approach to Diabetes Mellitus:

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The figure below shows diabetic patient self-administering insulin injection:

 

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My novel hypothesis on diabetes mellitus (DM):

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Everybody knows that insulin is the only treatment of type 1 diabetes mellitus (T1DM). However in type 2 diabetes mellitus (T2DM) diet, exercise, oral hypoglycemic agents (OHA) precede insulin therapy and only when OHA fails or severe diabetes at onset warrant insulin therapy. There are reports of short term early insulin therapy in all T2DM to protect b-cells of pancreas. I propose a hypothesis that every T2DM patient needs insulin treatment from day one of diagnosis and it ought to be continued indefinitely. By the time diagnosis of diabetes is made, 50 to 80 % of b-cells of pancreas are dead (dysfunctional). The logic is that exogenous insulin will reduce load on surviving b-cells of pancreas, protect surviving b-cells and achieve better glycemic control and reduce complications as rejuvenated surviving b-cells will increase or decrease insulin secretions depending on glucose level and food intake. Exogenous with endogenous insulin will ensure best overall glycemic control irrespective of timing & quantum of food intake. Weight gain occurs as a side effect of insulin therapy only when too much insulin and/or too much food is consumed. Too much insulin provokes hypoglycemia induced over-eating and too much food require more insulin to control blood sugar. When sub-optimal exogenous insulin is used with strict diet control, hypoglycemia and weight gain will be prevented. T2DM ought to be controlled by both exogenous and endogenous insulin. When food intake is lower than normal, endogenous insulin will fall. When food intake is more than normal, endogenous insulin will rise. In other words, hypoglycemia and hyperglycaemia will be prevented reducing complications of DM. Endogenous insulin acts more at liver than peripheral tissue while exogenous insulin act more at peripheral tissue than liver. Endogenous insulin is more physiological than exogenous insulin and therefore all attempts must be made to preserve endogenous insulin by preserving b-cells at any cost. Some OHA (sulfonylurea) stimulate b-cells to increase endogenous insulin secretion but in long run destroys b-cells (about 3-5 years). Also b-cell stimulation by these OHA is non-physiological; if patient has reduced or missed meal, it will still produce sufficient endogenous insulin to cause hypoglycemia. Such OHA must not be used in diabetic therapy as the goal is to conserve b-cells as long as possible. Longer the b-cells last, more physiological is diabetes control and lesser the diabetic complications. The combination of exogenous insulin plus endogenous insulin is better than only exogenous insulin when most b-cells die. Therefore all T2DM must be given at least sufficient exogenous insulin to take care of basal insulin requirement plus partial meal time requirement. All diabetic patients must be assessed for quantum of endogenous insulin secretion (b-cell function) and insulin resistance (i.e. inverse of insulin sensitivity) before starting exogenous insulin. T1DM means almost no endogenous insulin secretion, negligible b-cell function and lifetime full dose exogenous insulin; T2DM can have endogenous insulin secretion ranging from low to high level depending on insulin resistance and b-cell function. Exogenous insulin must be given to all T2DM including those with normal or high endogenous insulin level (insulin resistance) to reduce load on hyper-functioning b-cells and prolong their life. To better utilize insulin (endo/exo), insulin sensitivity must be enhanced (aka reduce insulin resistance) by diet control, weight reduction in obese, exercise, and use of OHA like metformin/ pioglitazone.

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Hyperglycemia is directly associated with microvascular complications, b-cell dysfunction and insulin resistance. Combining exogenous insulin with endogenous insulin will lead to better control of hyperglycemia than sole exogenous insulin when most b-cells die and sole endogenous insulin when sulfonylurea is used to stimulate b-cells in un-physiologic way. So sub-optimal exogenous insulin is the best treatment of T2DM to control hyperglycemia, reduce microvascular complications, and improve b-cell functions. Macrovascular complications are associated less with hyperglycemia and more with insulin resistance. So whether you give exogenous insulin or sulfonylurea, it would not reduce macrovascular complications. However, metformin and pioglitazone reduce insulin resistance; and combining exogenous insulin with metformin and/or pioglitazone would reduce macrovascular complications as well as reduce insulin requirement.

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Stages of T2DM:

Stage Plasma glucose in mg% Serum endogenous insulin Interpretation
Zero FPG 70-100; PPG 100-140 Slightly lower than normal Health conscious individual with normal weight, regular exercise and eating low glycemic index carb
One FPG 70-100; PPG 100-140 Normal insulin level So called normal people with normal b-cells and no insulin resistance, but eating high glycemic index carb and sedentary life
Two FPG 70-100; PPG 100-140 High insulin level Insulin resistance with hyper-functioning b-cells and increased b-cell mass e.g. obesity, no exercise.  I would call it pre-diabetes.  They are prone to macrovascular complications.
Three FPG > 100; PPG > 140 High insulin level Insulin resistance with hyper-functioning b-cells but reduced b-cell mass, I would call it early diabetes mellitus. They are prone to macrovascular and microvascular complications.
Four FPG > 100; PPG > 140 Normal insulin level Insulin resistance with some b-cell hyper-function and significant b-cell mass reduction. I would call it established diabetes mellitus.  They are prone to macrovascular and microvascular complications.
Five FPG > 100; PPG > 140 Low insulin level Insulin resistance with sub-total b-cell loss. I would call it severe diabetes mellitus.  They are prone to macrovascular and microvascular complications.

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As you can see that you can have normal blood sugar with varying insulin level. You can also have high blood sugar with varying insulin level. This proves that we need to do both blood sugar and blood endogenous insulin level to make accurate pathophysiological diagnosis of diabetes in order to determine insulin secretion and insulin resistance. I want to remove the term ‘impaired glucose tolerance’. Anybody with FPG > 100 mg% and PPG > 140 mg% is diabetic. Pre-diabetes means normal blood sugars but high endogenous insulin levels. A non-diabetic person means normal b-cells mass & function, and no insulin resistance (stage 0/1). Presence or absence of diabetic complications does not determine diagnosis of diabetes mellitus as besides hyperglycemia and insulin resistance, genetic factors also contributes to complications. The moment insulin resistance starts and/or b-cell loss starts with hyperglycemia, you are diabetic (stage 2/3/4/5). In other words, FPG 100 mg% and PPG 140 mg% are cut-off values. Anything less than that is non-diabetic provided their endogenous insulin values are not raised. Anything more than that is diabetic irrespective of endogenous insulin values.

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So I have put forward novel hypothesis on diabetes. Every patient suspected of diabetes must do, not only FPG, PPG and A1C but also fasting and postprandial serum insulin level for appropriate staging of DM. All DM patients need daily exogenous insulin from day 1 till person dies or in rare cases, till he becomes non-diabetic by life-style changes. Now let me go into the details of insulin therapy literature and various studies on DM vis-à-vis insulin, OHA and diabetic complications to determine whether my hypothesis holds true or fails.

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Glucose homeostasis:

Insulin and glucagon are potent regulators of glucose metabolism.  Plasma glucose concentration is a function of the rate of glucose entering the circulation (glucose appearance) balanced by the rate of glucose removal from the circulation (glucose disappearance). Circulating glucose is derived from three sources: intestinal absorption during the fed state, glycogenolysis, and gluconeogenesis. The major determinant of how quickly glucose appears in the circulation during the fed state is the rate of gastric emptying. Other sources of circulating glucose are derived chiefly from hepatic processes: glycogenolysis, the breakdown of glycogen, the polymerized storage form of glucose; and gluconeogenesis, the formation of glucose primarily from lactate and amino acids during the fasting state. Glycogenolysis and gluconeogenesis are partly under the control of glucagon, a hormone produced in the α-cells of the pancreas. During the first 8–12 hours of fasting, glycogenolysis is the primary mechanism by which glucose is made available. Glucagon facilitates this process and thus promotes glucose appearance in the circulation. Over longer periods of fasting, glucose, produced by gluconeogenesis, is released from the liver. For nondiabetic individuals in the fasting state, plasma glucose is derived from glycogenolysis under the direction of glucagon. Basal levels of insulin control glucose disposal. Insulin’s role in suppressing gluconeogenesis and glycogenolysis is minimal due to low insulin secretion in the fasting state. For nondiabetic individuals in the fed state, plasma glucose is derived from ingestion of nutrients. In the bi-hormonal model, glucagon secretion is suppressed through the action of endogenous insulin secretion. This action is facilitated through the paracrine route (communication within the islet cells). Additionally, in the fed state, insulin suppresses gluconeogenesis and glycogenolysis in the liver and promotes glucose disposal in the periphery. For individuals with diabetes in the fasting state, plasma glucose is derived from glycogenolysis and gluconeogenesis under the direction of glucagon. Exogenous insulin influences the rate of peripheral glucose disappearance and, because of its deficiency in the portal circulation, does not properly regulate the degree to which hepatic gluconeogenesis and glycogenolysis occur.  For individuals with diabetes in the fed state, exogenous insulin is ineffective in suppressing glucagon secretion through the physiological paracrine route, resulting in elevated hepatic glucose production. As a result, the appearance of glucose in the circulation exceeds the rate of glucose disappearance. The net effect is postprandial hyperglycemia.

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The idealized diagram above shows the fluctuation of blood sugar (red) and the sugar-lowering hormone insulin (blue) in humans during the course of a day containing three meals. In addition, the effect of a sugar-rich versus a starch-rich meal is highlighted. It’s the higher carbohydrate meals that elevate insulin levels the most after a meal. It’s important to note that Insulin is sensitive to both carbohydrate and protein consumed, but not fat. However, of all the food sources, it’s the higher carbohydrate meals that elevate Insulin levels the most after a meal. Even though there are individual differences to insulin sensitivity levels depending upon your metabolic type, the evidence strongly suggests that the leaner and lighter you become the stronger your insulin sensitivity levels will be. This means carbohydrates (and protein to a lesser extent) are producing a bigger and more powerful anabolic effect the closer you get to your weight loss/body fat goals.

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Hormones that influence blood glucose level:

New understanding of the roles of other pancreatic and incretin hormones has led to a multi-hormonal view of glucose homeostasis besides insulin and glucagon. Glucoregulatory hormones include insulin, glucagon, amylin, GLP-1, glucose-dependent insulinotropic peptide (GIP), epinephrine, cortisol, and growth hormone. Of these, insulin and amylin are derived from the β-cells, glucagon from the α-cells of the pancreas, and GLP-1 and GIP from the L-cells of the intestine.

Hormone Tissue of Origin Metabolic Effect Effect on Blood Glucose
Insulin Pancreatic β Cells 1) Enhances entry of glucose into cells; 2) Enhances storage of glucose as glycogen, or conversion to fatty acids; 3) Enhances synthesis of fatty acids and proteins; 4) Suppresses breakdown of proteins into amino acids, of adipose tissue into free fatty acids. Lowers
Somatostatin Pancreatic δ Cells 1) Suppresses glucagon release from α cells (acts locally); 2) Suppresses release of Insulin, Pituitary tropic hormones, gastrin and secretin. Lowers
Glucagon Pancreatic α Cells 1) Enhances release of glucose from glycogen; 2) Enhances synthesis of glucose from amino acids or fatty acids. Raises
Epinephrine Adrenal medulla 1) Enhances release of glucose from glycogen; 2) Enhances release of fatty acids from adipose tissue. Raises
Cortisol Adrenal cortex 1) Enhances gluconeogenesis; 2) Antagonizes Insulin. Raises
ACTH Anterior pituitary 1) Enhances release of cortisol; 2) Enhances release of fatty acids from adipose tissue. Raises
Growth Hormone Anterior pituitary Antagonizes Insulin Raises
Thyroxine Thyroid 1) Enhances release of glucose from glycogen; 2) Enhances absorption of sugars from intestine Raises

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Insulin:

Insulin is a very old protein that may have originated more than a billion years ago. The molecular origins of insulin go at least as far back as the simplest unicellular eukaryotes.  Apart from animals, insulin-like proteins are also known to exist in Fungi and Protista kingdoms. Within vertebrates, the amino acid sequence of insulin is strongly conserved. Bovine insulin differs from human in only three amino acid residues, and porcine insulin in one. Even insulin from some species of fish is similar enough to human to be clinically effective in humans. Insulin in some invertebrates is quite similar in sequence to human insulin, and has similar physiological effects. The strong homology seen in the insulin sequence of diverse species suggests that it has been conserved across much of animal evolutionary history.

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Insulin and pancreas:

Pancreatic beta cells are found in the islets of Langerhans, which are of various size and contain a few hundred to a few thousand endocrine cells. Islets are anatomically and functionally separate from pancreatic exocrine tissue (which secretes pancreatic enzymes and fluid directly into ducts that drain into the duodenum). Normal subjects have about one million islets that in total weigh 1 to 2 grams and constitute 1 to 2 percent of the mass of the pancreas. Islets vary in size from 50 to 300 micrometers in diameter. They are composed of several types of cells. At least 70 percent are beta cells, which are localized in the core of the islet. These cells are surrounded by alpha cells that secrete glucagon, smaller numbers of delta cells that secrete somatostatin, and PP cells that secrete pancreatic polypeptide. All of the cells communicate with each other through extracellular spaces and through gap junctions. This arrangement allows cellular products secreted from one cell type to influence the function of downstream cells. As an example, insulin secreted from beta cells suppresses glucagon secreted from alpha cells.  A neurovascular bundle containing arterioles and sympathetic and parasympathetic nerves enters each islet through the central core of beta cells. The arterioles branch to form capillaries that pass between the cells to the periphery of the islet and then enter the portal venous circulation.

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The human insulin protein is composed of 51 amino acids, and has a molecular mass of 5808 Da. The primary structure of insulin is made from two polypeptide chains named subunit A and B. Subunit A consists of 21 amino acids, whereas subunit B consists of 30 amino acids. These chains are connected by two disulfide bridges as seen in figure below. Insulin also forms quaternary structure by creating diamers using hydrogen bonds and hexamers by bonding with two zinc ions. Insulin’s small size allows it to be a ligand for other proteins appropriately named insulin receptors. Inactive insulin is stored in the body as a hexamer, while the active form is the monomer. The hexamer is an inactive form with long-term stability, which serves as a way to keep the highly reactive insulin protected, yet readily available. The hexamer-monomer conversion is one of the central aspects of insulin formulations for injection. The hexamer is far more stable than the monomer, which is desirable for practical reasons; however, the monomer is a much faster-reacting drug because diffusion rate is inversely related to particle size (e.g., rapid acting insulin analogue). A fast-reacting drug means insulin injections do not have to precede mealtimes by hours, which in turn gives people with diabetes more flexibility in their daily schedules.

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In the beta cells of the pancreas, the insulin molecule is originally produced as a single molecule (preproinsulin) composed of 110 amino acids. It passes through the endoplasmic reticulum and 24 amino acids (“the signal peptide”) are removed by enzyme action from one end of the chain, leaving another form (pro-insulin) behind. The proinsulin folds and binds to give the molecule its final structure. Then the proinsulin passes into vesicles budded off from the Golgi body. Thereafter the middle section (“the C chain”) of 33 amino-acids is removed by the action of the enzymes prohormone convertase 1 and 2, converting it into the final structure with 2 chains, A and B. Further 2 amino acids are removed by another enzyme carboxypeptidase E. Proinsulin is cleaved into equimolar amounts of insulin and C-peptide in the secretory granules. The process of insulin secretion involves fusion of the secretory granules with the cell membrane and exocytosis of insulin, C-peptide, and proinsulin.

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Insulin is a peptide hormone composed of 51 amino acids that is synthesized, packaged, and secreted in pancreatic beta cells. Insulin is secreted in response to increased blood glucose and amino acids following ingestion of a meal. Like many hormones, insulin exerts its actions through binding to specific receptors present on many cells of the body, including fat, liver, and muscle cells. The primary action of insulin is to stimulate glucose disappearance. Insulin helps control postprandial glucose in three ways. Initially, insulin signals the cells of insulin-sensitive peripheral tissues, primarily skeletal muscle, to increase their uptake of glucose. Secondly, insulin acts on the liver to promote glycogenesis. Finally, insulin simultaneously inhibits glucagon secretion from pancreatic α-cells, thus signalling the liver to stop producing glucose via glycogenolysis and gluconeogenesis. All of these actions reduce blood glucose. Other actions of insulin include the stimulation of fat synthesis, promotion of triglyceride storage in fat cells, promotion of protein synthesis in the liver and muscle, and proliferation of cell growth. Insulin action is carefully regulated in response to circulating glucose concentrations. Insulin is not secreted if the blood glucose concentration is ≤ 3.3 mmol/l, but is secreted in increasing amounts as glucose concentrations increase beyond this threshold. Postprandially, the secretion of insulin occurs in two phases: an initial rapid release of preformed insulin, followed by increased insulin synthesis and release in response to blood glucose. Long-term release of insulin occurs if glucose concentrations remain high. While glucose is the most potent stimulus of insulin, other factors stimulate insulin secretion. These additional stimuli include increased plasma concentrations of some amino acids, especially arginine, leucine, and lysine; GLP-1 and GIP released from the gut following a meal; and parasympathetic stimulation via the vagus nerve.

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Fully functional beta cells are metabolically very active, shedding and replacing 30–50% of their surface membrane daily in the course of insulin secretion. A lean healthy individual might secrete about 35 units of insulin per day, yet will have about 10 times this amount stored within his pancreas. By contrast, an obese insulin-resistant person might need to produce >100 units daily to maintain normal blood glucose levels. Type 1 diabetes results from progressive beta cell loss by apoptosis, thus increasing the work-load of the residue. A further consequence is loss of beta to beta cell communication and an altered cell-to-cell (paracrine) interaction between beta cells and glucagon-producing alpha cells. Coordinated pulsatile release of insulin deteriorates during the type 1 diabetes prodrome, and results in loss of efficacy in regulating glucose output by liver cells (hepatic insulin resistance). Blood glucose rises, increasing the workload of the remaining beta cells, and may further impair their function by the effect known as glucose toxicity. There are indications that functional defects are present at diagnosis of type 1 diabetes, and may recover to some extent in the period following diagnosis.

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Oscillations of insulin release:

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Insulin release from pancreas oscillates with a period of 3–6 minutes.

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Even during the digestion, in general, one or two hours following a meal, insulin release from the pancreas is not continuous, but oscillates with a period of 3–6 minutes, changing from generating a blood insulin concentration more than about 800 pmol/l to less than 100 pmol/l. This is thought to avoid downregulation of insulin receptors in target cells, and to assist the liver in extracting insulin from the blood. This oscillation is important to consider when administering insulin-stimulating medication, since it is the oscillating blood concentration of insulin release, which should, ideally, be achieved, not a constant high concentration. This may be achieved by delivering insulin rhythmically to the portal vein or by islet cell transplantation to the liver. It is hoped that future insulin pumps will address this characteristic.

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Basal Insulin Release:

The beta-cells of a healthy person who has not eaten for a while release a small amount of insulin into the blood stream throughout the day and night in the form of very small pulses every few minutes. This is called “basal insulin release.”

Maintaining this steady supply of insulin is important. It allows the cells of the body to utilize blood sugar even if some time has passed since a meal. The steady insulin level as another function, too. A dropping insulin level signals the liver that blood sugar is getting low and that it is time to add more glucose. When this happens, the liver converts the carbohydrate it has stored, (known as glycogen) into glucose, and dumps it into the blood stream. This raises the blood sugar back to its normal level. If a person has exhausted their glycogen stores, as can happen on a low carbohydrate diet, the liver converts protein into glucose to provide the glucose it makes in response to a low level of insulin in the blood. The protein can come from dietary protein or from your body’s own muscles. That is why dieters can lose significant amounts of muscle mass if they don’t get enough protein when they diet. Of course with every meal, there is bolus insulin secreted in addition to basal release to take care of excess glucose.

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First Phase Insulin Release:

When a health person starts to eat a meal, the beta-cells kick into high gear. Their stored insulin is released immediately. Then, if the blood sugar concentration rises over 100 mg/dl, (5.5 mmol/L) the beta-cells start secreting more insulin into the blood stream. This early release of stored insulin after a meal is called “First Phase Insulin Release.” In a healthy person it keeps the blood sugar from rising very high because it is available to meet most of the glucose that comes from the digestion of the current meal. The amount of insulin secreted in the first phase response to a meal is usually determined by the amount of glucose encountered in the previous meal. In a healthy person, this first phase response peaks a few minutes after you’ve started your meal. The blood sugar rise caused by the meal peaks about half an hour after you start eating.

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Second Phase Insulin Release:

After completing the first phase insulin release, the beta-cells pause. Then, if blood sugar is still not back under 100 mg/dl (5.5 mmol/L) ten to twenty minutes later, they push out another, smaller second phase insulin response which, in a healthy person, brings the blood sugar back down to its starting level, usually within an hour to an hour and a half after the start of a meal.

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It is this combination of a robust first phase insulin response followed by a functional second phase insulin response that keeps the blood sugar of a normal person from ever rising over 140 mg/dl(7.8 mmol/L) even after a high carbohydrate meal. When first phase insulin response is completely functional, the blood sugar level at two hours should be back to the normal fasting blood sugar level which is somewhere in the mid 80 mg/dl range (4.5 mmol/L). When first phase release fails, or when second phase insulin response is sluggish, blood sugars start to rise to higher levels after a meal and take longer to return to normal. This condition is called “impaired glucose tolerance.” If the blood sugar rises over 200 mg/dl (11 mmol/L) after a meal the same condition is called “Diabetes.”

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Incretin hormones GLP-1(Glucagon-like peptide-1) and GIP (Gastric inhibitory polypeptide):

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The intricacies of glucose homeostasis become clearer when considering the role of gut peptides. By the late 1960s, Perley and Kipnis and others demonstrated that ingested food caused a more potent release of insulin than glucose infused intravenously. This effect, termed the “incretin effect,” suggested that signals from the gut are important in the hormonal regulation of glucose disappearance. Additionally, these hormonal signals from the proximal gut seemed to help regulate gastric emptying and gut motility.  Several incretin hormones have been characterized, and the dominant ones for glucose homeostasis are GIP and GLP-1. GIP stimulates insulin secretion and regulates fat metabolism, but does not inhibit glucagon secretion or gastric emptying.  GIP levels are normal or slightly elevated in people with type 2 diabetes. While GIP is a more potent incretin hormone, GLP-1 is secreted in greater concentrations and is more physiologically relevant in humans. GLP-1 also stimulates glucose-dependent insulin secretion but is significantly reduced postprandially in people with type 2 diabetes or impaired glucose tolerance.  GLP-1 stimulates insulin secretion when plasma glucose concentrations are high but not when plasma glucose concentrations approach or fall below the normal range. Derived from the proglucagon molecule in the intestine, GLP-1 is synthesized and secreted by the L-cells found mainly in the ileum and colon. Circulating GLP-1 concentrations are low in the fasting state. However, both GIP and GLP-1 are effectively stimulated by ingestion of a mixed meal or meals enriched with fats and carbohydrates.  In contrast to GIP, GLP-1 inhibits glucagon secretion and slows gastric emptying. GLP-1 has many glucoregulatory effects. In the pancreas, GLP-1 stimulates insulin secretion in a glucose-dependent manner while inhibiting glucagon secretion.  Animal studies have demonstrated that the action of GLP-1 occurs directly through activation of GLP-1 receptors on the pancreatic β-cells and indirectly through sensory nerves. GLP-1 has a plasma half-life of about 2 minutes, and its disappearance is regulated primarily by the enzyme dipeptidyl peptidase-IV (DPP-IV), which rapidly cleaves and inactivates GLP-1. Infusion of GLP-1 lowers postprandial glucose as well as overnight fasting blood glucose concentrations. The postprandial effect of GLP-1 is partly due to inhibition of glucagon secretion. Yet while GLP-1 inhibits glucagon secretion in the fed state, it does not appear to blunt glucagon’s response to hypoglycemia. GLP-1 helps regulate gastric emptying and gastric acid secretion, perhaps by signalling GLP-1 receptors in the brain and thereby stimulating efferent tracts of the vagus nerve. As gastric emptying slows, the postprandial glucose excursion is reduced. Administration of GLP-1 has been associated with the regulation of feeding behavior and body weight.  In addition, there have been reported observations of GLP-1 improving insulin sensitivity and enhancing glucose disposal. Of significant and increasing interest is the role GLP-1 may have in preservation of β-cell function and β-cell proliferation. In animal studies, GLP-1 has been shown to enhance functional β-cell mass.

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Amylin and Connecting peptide (C-peptide):

In addition to insulin, beta cells also secrete the hormone Amylin and C-peptide, a by-product of insulin production. Amylin slows the rate of glucose entering the bloodstream, making it a more short-term regulator of blood glucose levels. C-peptide is a molecule that helps to prevent neuropathy and other vascular complications by assisting in the repair of the muscular layers of the arteries.  It is secreted into the bloodstream in equal quantities (or moles) to insulin.

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The figure below shows C-peptide component of proinsulin:

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Amylin:

Isolated from pancreatic amyloid deposits in the islets of Langerhans, amylin was first reported in the literature in 1987. Amylin, a 37–amino acid peptide, is a neuroendocrine hormone co-expressed and co-secreted with insulin by pancreatic β-cells in response to nutrient stimuli.  When secreted by the pancreas, the insulin-to-amylin molar ratio in the portal circulation is approximately 50:1. Because of hepatic extraction of insulin, this ratio falls to ∼ 20:1 in the peripheral circulation. Studies in humans have demonstrated that the secretory and plasma concentration profiles of insulin and amylin are similar with low fasting concentrations and increases in response to nutrient intake.  In healthy adults, fasting plasma amylin concentrations range from 4 to 8 pmol/l rising as high as 25 pmol/l postprandially. In subjects with diabetes, amylin is deficient in type 1 and impaired in type 2 diabetes.  Preclinical findings indicate that amylin works with insulin to help coordinate the rate of glucose appearance and disappearance in the circulation, thereby preventing an abnormal rise in glucose concentrations. Amylin complements the effects of insulin on circulating glucose concentrations via two main mechanisms. Amylin suppresses post-prandial glucagon secretion, thereby decreasing glucagon-stimulated hepatic glucose output following nutrient ingestion. This suppression of post-prandial glucagon secretion is postulated to be centrally mediated via efferent vagal signals. Importantly, amylin does not suppress glucagon secretion during insulin-induced hypoglycemia. Amylin also slows the rate of gastric emptying and, thus, the rate at which nutrients are delivered from the stomach to the small intestine for absorption.  In addition to its effects on glucagon secretion and the rate of gastric emptying, amylin dose-dependently reduces food intake and body weight in animal models. Amylin exerts its actions primarily through the central nervous system. Animal studies have identified specific calcitonin-like receptor sites for amylin in regions of the brain, predominantly in the area postrema. The area postrema is a part of the dorsal vagal complex of the brain stem. A notable feature of the area postrema is that it lacks a blood-brain barrier, allowing exposure to rapid changes in plasma glucose concentrations as well as circulating peptides, including amylin.  In summary, amylin works to regulate the rate of glucose appearance from both endogenous (liver-derived) and exogenous (meal-derived) sources, and insulin regulates the rate of glucose disappearance.

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Insulin receptors:

Insulin exerts all of its biological activities, both as a hormone and as a growth factor, by binding to a cell surface receptor complex. The insulin receptor is a member of the membrane-spanning receptor family that harbors intrinsic tyrosine kinase activity. However, the insulin receptor is unique in that it is a heterotetrameric complex composed of two completely extracellular α-peptides that are disulfide bonded to the two transmembrane-spanning β-peptides. Both the α- and β- subunits of the receptor complex are derived from a single gene. When insulin binds to the receptor it activates the intrinsic tyrosine kinase activity of the β-subunits resulting in autophosphorylation of the receptor. The insulin receptor is a transmembrane receptor that is activated by insulin, IGF-I, IGF-II and belongs to the large class of tyrosine kinase receptors.  Metabolically, the insulin receptor plays a key role in the regulation of glucose homeostasis, a functional process that under degenerate conditions may result in a range of clinical manifestations including diabetes and cancer. Tyrosine kinase receptors, including the insulin receptor, mediate their activity by causing the addition of a phosphate group to particular tyrosines on certain proteins within a cell. The “substrate” proteins that are phosphorylated by the Insulin Receptor include a protein called “IRS-1″ for “insulin receptor substrate 1″. IRS-1 binding and phosphorylation eventually leads to an increase in the high affinity glucose transporter (Glut4) molecules on the outer membrane of insulin-responsive tissues, including muscle cells and adipose tissue, and therefore to an increase in the uptake of glucose from blood into these tissues.  In other words, the glucose transporter Glut4 is transported from cellular vesicles to the cell surface, where it then can mediate the transport of glucose into the cell.

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Degradation of insulin:

Once an insulin molecule has docked onto the receptor and effected its action, it may be released back into the extracellular environment or it may be degraded by the cell. Degradation normally involves endocytosis of the insulin-receptor complex followed by the action of insulin degrading enzyme. Most insulin molecules are degraded by liver cells. An insulin molecule produced endogenously by the pancreatic beta cells is estimated to be degraded within about one hour after its initial release into circulation (insulin half-life ~ 4–6 minutes).

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Insulin actions:

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The figure below shows synopsis of metabolic actions of insulin:

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Metabolic actions of insulin help to maintain glucose homeostasis and promote glucose utilization in the body. Insulin increases glucose utilization in peripheral organs (e.g., skeletal muscle and adipose tissue) and suppresses hepatic glucose production (HGP). In addition to these classical metabolic insulin target tissues, there are many other important physiological targets of insulin including the brain, pancreatic beta cells, heart, and vascular endothelium that help to coordinate and couple metabolic and cardiovascular homeostasis under healthy conditions. Insulin has concentration-dependent saturable actions to increase whole-body glucose disposal. The maximal effect of insulin defines “insulin responsiveness” while the insulin concentration required for a half-maximal response defines “insulin sensitivity”. Although, other actions of insulin on fat and amino-acid metabolism, cardiovascular, kidney, and brain function also exhibit a concentration-dependent response, the term “insulin sensitivity” typically refers to insulin’s metabolic actions to promote glucose disposal.

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Insulin Action and Endothelial Functions:

The metabolic functions of insulin are primarily reflective of its role in glucose and lipid homeostasis in skeletal muscle, adipose tissue, and liver. However, insulin also exerts important functions in other non-classical insulin target tissues such as the brain, pancreas, and the vascular endothelium. The ability of insulin to exert vasodilator action in the vascular endothelium as a result of increased nitric oxide (NO) production is an important component of the ability of this hormone to enhance glucose uptake by skeletal muscle. The insulin-mediated signalling pathway that triggers production of NO in vascular endothelium involves the same signalling proteins (PI3K, PKD, and PKB/Akt) that are components of metabolic regulatory pathways induced by insulin. Therefore, it is understandable why the same disruptions to insulin signalling that lead to insulin resistance caused by excess FFAs and hyperglycemia result in endothelial dysfunction.

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Insulin potassium relationship:

Serum potassium concentration (K+) reflects total body potassium stores at the steady state, although this relationship can be disturbed in disorders of potassium distribution. Plasma K+ is a major determinant of the resting potential of all cells. Hyperkalemia and hypokalemia are silent yet fatal disturbances because of their arrhythmogenic potentials. Insulin was shown to be an important regulator of potassium homeostasis shortly after its discovery. Insulin causes potassium to shift into the cells thereby decreasing the extracellular K level. That’s why insulin is used in the treatment of hyperkalemia.  Basal insulin maintains fasting plasma [K+] within the normal range. When insulin levels are suppressed, plasma [K+] rises and pronounced hyperkalemia develops after a potassium load. Hyperkalemia is often encountered in patients with diabetes. The insulin-deficient state in type 1 diabetes predisposes to hyperkalemia because of an impaired ability of potassium to enter cells. During hyperglycemic hypertonic states in type 1 and type 2 diabetics, potassium is carried out of cells by convective flux as the most abundant intracellular cation. Even at the steady state in a significant portion of type 1 and type 2 diabetics, there is an impaired ability of the distal nephron to excrete potassium because of hyporeninemic hypoaldosteronism or tubular insensitivity to aldosterone. Finally, one wonders whether there is impaired cellular potassium uptake in type 2 diabetes as part of a generalized insulin-resistant state. Level of potassium in the serum also affects insulin secretion from the pancreas. Because the beta cells have an ATP dependent K channel which is when closed leads to retained K inside the beta cell which favors depolarization thereby enhancing Calcium mediated release of secretory granules. Therefore, in hyperkalemia more K will enter the beta cell and insulin secretion will increase and conversely in hypokalemia the K ions are more likely to leave the beta cell and so insulin secretion will decrease. Potassium is a well proven insulin secretagogue in the intact organism and the isolated pancreas. Insulin is a key defender against exogenous potassium load by using intracellular buffering to minimize hyperkalemia before renal excretion.

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One ponders whether there should be any teleogic reasons of coupling glucose to potassium uptake. In the postprandial state of herbivores or carnivores, caloric and potassium influx are concurrent. In a feast-or-famine situation in hunting carnivores, the magnitude of the load is much exaggerated. The simultaneous shift of glucose and potassium into cells makes physiologic sense with the postprandial outpouring of insulin. Similarly, dietary phosphate frequently accompanies caloric intake, and upon entry into cells, glucose is phosphorylated; thus, simultaneous phosphate uptake also makes physiologic sense. However, if potassium, phosphate, and glucose loads are applied discordantly, the simultaneous cellular uptake will clearly present a homeostatic quandary and some means of dissociation is mandatory. Previous studies have addressed whether potassium and glucose uptake are coupled. DeFronzo et al. observed a relationship between the decline in plasma [K+] and insulin level as well the total amount of glucose taken up by cells. Arslanian et al. concluded that insulin-dependent diabetics have impaired potassium uptake. However, Cohen et al. found independent actions of insulin on glucose and potassium uptake. Another study concluded that glucose and potassium uptake are differentially regulated and that impaired glucose disposal does not affect potassium uptake.

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Insulin and C-peptide level:

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Insulin level:

Elevated level of fasting insulin is the single greatest marker to assess a person’s cardiovascular and diabetic risk factors. This has been consistently demonstrated in the medical literature going back more than 20 years. Elevated levels of insulin are found among those with heart disease, congestive heart failure, insulin resistance, diabetes, high blood pressure, and obesity. Dr. Joseph Mercola says fasting insulin is “the number that may best predict your sudden death.”  But what does it mean? So a fasting insulin level should never be 0, which it might be in a person with untreated Type 1 DM. It shouldn’t go below 3 mU/L. But a high insulin level is just as problematic. A high insulin level is a sign of insulin resistance or prediabetes. It can also signify early-stage Type 2 DM. According to Dr. Mercola, too much insulin promotes weight gain by storing fat. It promotes insulin resistance, lowers magnesium levels, and increases inflammation. It also tends to lower HDL (“good”) cholesterol and raise levels of LDL (“bad”) cholesterol. All of these increase the risk of diabetes and heart disease.

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Serum Insulin and other Cardiovascular Risk Indicators in Children, Adolescents and Young Adults: 1991 study:

Serum insulin correlated positively with body mass index, concentrations of serum triglycerides, and blood pressure, and inversely with the concentration of high density lipoprotein cholesterol. High triglycerides, high systolic blood pressure, and low level of high density lipoprotein cholesterol clustered among subjects within the highest insulin quartile. The results suggest that the insulin resistance phenomenon, caused mainly by obesity and leading to unfavourable levels of other coronary heart disease risk indicators, is already developing in children and young adults. This suggests that preventing obesity in early life is important.

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Serum insulin or plasma insulin?

The concentration of insulin was measured by double-antibody immunoassay simultaneously in the plasma and serum of thirty-eight fasting and non-fasting individuals. The concentration found in heparin-plasma was consistently higher than that found in serum, and experiments suggest that the high plasma-level is an effect of heparin. Evidence from previous workers (who have measured the hormone’s concentration in plasma and serum separately) would seem to support this. It is proposed that insulin should always be assayed in serum.

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Insulin secretion is hard to evaluate on the basis of blood samples taken from a peripheral vein. This is because a high proportion of the insulin secreted by the pancreas is cleared on first passage through the liver. The liver is thus exposed to higher concentrations of insulin, delivered in pulses. The systemic circulation sees lower insulin levels with small pulses, since these are largely eliminated in passage through the liver. Furthermore, insulin has a half-life of about 6 minutes in the circulation, so very frequent sampling is needed to monitor its fluctuations. Last but not least, people on insulin typically have low levels of insulin antibodies in the circulation, which complicates accurate measurement in the insulin assay. These limitations can largely be overcome by measuring C-peptide in the plasma or urine. C-peptide is a short peptide sequence released from the proinsulin molecule on a one-to-one ratio as insulin is secreted. C-peptide is not cleared by liver (it is excreted via the kidney) and has a plasma half-life of about 30 minutes. Stressed beta cells accelerate insulin production and secretion, and one consequence is that the proportion of proinsulin to cleaved insulin entering the circulation is increased. A raised proinsulin: insulin ratio is thus a marker of beta cell distress and, since proinsulin has less metabolic effect than cleaved insulin, insulin action is also reduced. The main analytical pitfalls in insulin measurement in serum are related to (a) hemolysis, (b) circulating antiinsulin autoantibodies, and, for the past few years, (c) the reactivity (or lack of reactivity) of rapid- or long-acting pharmacological insulin analogs in sera. Hemolyzed samples contain an insulin-degrading enzyme and should not be analyzed unless they can be handled at 4 °C within ∼2–3 h or an insulinase inhibitor has been added in the blood collection tube to prevent insulin degradation. Antiinsulin antibodies interfere with RIAs and IMAs, yielding overestimated values for free insulin, the biologically active form of insulin, that is not bound to antiinsulin antibodies in serum. Measurement of free insulin requires the removal of antiinsulin antibodies, which can be achieved by polyethylene glycol precipitation. Insulin testing may be ordered with glucose and C-peptide tests. Insulin levels are also sometimes used in conjunction with the glucose tolerance test (GTT). In this situation, blood glucose and insulin levels are measured at pre-established time intervals to evaluate insulin resistance. Physicians ordering insulin assays should be informed in detail about the used assay system in order to interpret the results appropriately.

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Reference Range of serum insulin:

Insulin is an anabolic hormone that promotes glucose uptake, glycogenesis, lipogenesis, and protein synthesis of skeletal muscle and fat tissue through the tyrosine kinase receptor pathway. In addition, insulin is the most important factor in the regulation of plasma glucose homeostasis, as it counteracts glucagon and other catabolic hormones—epinephrine, glucocorticoid, and growth hormone.

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One international unit of insulin (1 IU) is defined as the “biological equivalent” of 34.7 μg pure crystalline insulin. This corresponds to the old USP insulin unit, where one unit (U) of insulin was set equal to the amount required to reduce the concentration of blood glucose in a fasting rabbit to 45 mg/dl (2.5 mmol/L). The unit of measurement used in insulin therapy is not part of the International System of Units (abbreviated SI) which is the modern form of the metric system. Instead the pharmacological international unit (IU) is defined by the WHO Expert Committee on Biological Standardization.

Conversion factor:

1 IU = 0.0347 mg insulin human (Ph Eur) or 1 USP unit = 0.0347 mg (USP).

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Remember, micro-units per milliliter = milli-units per liter.

µU/mL = mU/L

The blood content of insulin can be measured in international units, such as µU/mL or in molar concentration, such as pmol/L, where 1 µU/mL equals 6.945 pmol/L.

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Reference Range of Insulin Levels in one laboratory:

Insulin Level Insulin Level (SI Units)
Fasting < 25 mU/L < 174 pmol/L
30 minutes after glucose administration 30-230 mU/L 208-1597 pmol/L
1 hour after glucose administration 18-276 mU/L 125-1917 pmol/L
2 hour after glucose administration 16-166 mU/L 111-1153 pmol/L
≥3 hours after glucose administration < 25 mU/L < 174 pmol/L

The reference range for the normal level for insulin concentrations in serum samples in many laboratories is being given from 5 – 25 µU/mL.  This range is only valid for overnight fasted patients (12 hours) with normal weight, without diabetes mellitus, and during normal caloric nutrition and normal insulin sensitivity – which cannot be accurately measured by simple techniques rather than estimated.

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A typical blood level between meals is 8–11 μIU/mL (57–79 pmol/L). Unfortunately, there isn’t much agreement on what level is ideal. The Web site Health Central says 10–20. Dr. Mercola says less than 5.  Fasting serum insulin is quite distinct for males and for females… for males it is an average of 11.5 mU/l and for females it is 8.7 mU/l. Two hours after stimulating the pancreas to release insulin, through what is called the insulin tolerance test in which they give the patient sugar to drink, 120 minutes later insulin circulating in blood is 54.6 and 34.6 for females. A study in Arizona found that women with a fasting insulin level around 8.0 had twice the risk of prediabetes as did women with a level around 5.0. Women with a fasting insulin of 25 or so had five times the risk of prediabetes.

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How to lower insulin level:

Lowering insulin levels seems pretty similar to lowering glucose. Authorities like Dr. Mercola say the key is to reduce intake of sugar and grains. Those foods stimulate insulin production. Refined grains and fructose-sweetened drinks are the worst, he says. Better to eat fats and proteins. Writing on Livestrong.com, Andy Jackson has a somewhat different take. “Increase your intake of fresh fruits and vegetables, whole grains and lean proteins,” he says. “Avoid processed and fast foods, which are high in sugar, fat, and salt.” Exercise also lowers insulin levels and insulin resistance.

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Insulin testing may be used to help:

•Diagnose an insulinoma, verify that removal of the tumour has been successful, and/or to monitor for recurrence

•Diagnose the cause of hypoglycemia in an individual with signs and symptoms

•Identify insulin resistance

•Monitor the amount of insulin produced by the beta cells in the pancreas (endogenous); in this case, a C-peptide test may also be done. Insulin and C-peptide are produced by the body at the same rate as part of the conversion of proinsulin to insulin in the pancreas. Both tests may be ordered when a health practitioner wants to evaluate how much insulin in the blood is made by the body and how much is from outside (exogenous) sources such as insulin injections. The test for insulin measures insulin from both sources while the C-peptide test reflects insulin produced by the pancreas.

•Determine when a type 2 diabetic might need to start taking insulin to supplement oral medications

•Determine and monitor the success of an islet cell transplant intended to restore the ability to make insulin, by measuring the insulin-producing capacity of the transplant.

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C-peptide level in blood:

C-peptide is a chain of proteins that is spun off in the process by which the beta cell makes insulin. During this process, a precursor molecule, proinsulin is split into insulin and C-peptide. So for every molecule of insulin your beta cells produce, they also produce a molecule of C-peptide.  C-peptide is removed from the bloodstream by your kidneys while insulin is removed by the liver. This makes a difference in how long these peptides stay in the bloodstream. It takes half an hour until C-peptide is removed, while insulin is gone in five minutes. This means that there should be five times as much C-peptide in your blood at any given time as there is insulin and the longer activity period should smooth out the effects of testing at any one particular moment.  However, if there is something wrong with your kidneys they may not remove C-peptide in a normal manner and the result of a C-peptide test may be misleading.  If a person is injecting insulin, measuring C-peptide is the only way doctors can determine whether they are also making insulin on their own since lab tests do not distinguish between injected insulin and endogenous insulin. Some doctors prefer to measure C-peptide even in people not injecting insulin because of its longer life in the bloodstream which means you won’t see as much fluctuation from moment to moment in C-peptide levels as you may find with insulin levels.

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Interpreting the results of the C-Peptide Test:

The C-Peptide test measures how much insulin is released from the pancreas, when stimulated by glucose to do so.  According to Mosby’s Manual of Diagnostic and Laboratory Tests – Second Edition, “The exogenously administered insulin suppresses endogenous insulin production.”  More accurately, exogenous insulin controls blood glucose concentrations, thus preventing stimulation of endogenous insulin release, which may in effect suppress endogenous insulin production. C-Peptide is not a test for insulin production, but a test for insulin released from the pancreas. To understand how the pancreatic beta cells are working one needs to look at the C-Peptide test and at the blood glucose level at the time of test, and consider all the factors that contribute to hyperglycemia, to arrive at an objective conclusion. As a blood glucose load increases, the C-Peptide levels increase due to endogenous insulin release. In T1DM, C-peptide test is negative as no endogenous insulin secreted. Even in T2DM on exogenous insulin controlling blood sugar, C-peptide test can be negative as endogenous insulin secretion is suppressed and you may falsely label T2DM as T1DM. So to stimulate the pancreas to release insulin before taking the C-Peptide test, increase the blood glucose above normal for at least one hour before taking the blood test. This should help exculpate the pancreas and prove that maybe the beta cells are there and functioning albeit lesser than normal, proving T2DM.

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C-peptide concentration in ng/mL X 0.331 = C-peptide concentration in nmol/L.

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Range of C peptide:

Fasting range is: 0.78 – 1.89 ng/ml (0.26 – 0.62 nmol/L)

Range one hour after a glucose load is: 5.00 -12.00 ng/ml (During a glucose tolerance test)

Other labs give the fasting C-peptide assay with a “normal” reference range is between 1.5 – 3.5 ng/mL (0.5-1.15 nmol/L). The complete human C-Peptide range as opposed to the “normal” range is in fact 0.6 – 12.0 ng/ml, keep in mind that the normal values are for a non-diabetic person.

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The values will be lower in an insulin user and higher in a type 2 oral agent user (agents that promote the release of insulin from the pancreas) when blood glucose levels are controlled. The C-Peptide test is mostly used to diagnose and evaluate patients who are hypoglycemic (produce too much insulin) as well as those who have insulinomas (insulin producing tumors).  The test is also used to see if a normal person is secretly using insulin. They may ask patients to fast for this test (to reduce glucose levels in the blood) to establish a baseline in hypoglycemia cases. This is currently a standard procedure for this test. In diabetics however the baseline has to be the opposite, to increase glucose levels in the blood, in order to prove type 2 DM. Fasting may not yield the intended results. Do not fast when testing C-peptide in diabetics. This can be a problem for those of us who have forms of diabetes where our beta cells are able to secrete basal insulin (the slow steady drip of insulin that keeps our blood sugar normal in the fasting state) but are unable to secrete insulin in response to the rising blood glucose that happens at meal time.

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A very low C-peptide result is the definitive way to diagnose severe Type 1 diabetes–though many people with Type 1 will continue to have a low level of C-peptide in their blood for years after diagnosis as good control started soon after at Type 1 diagnosis appears to keep a small number of their beta cells alive.  To derive more meaning for the results of a C-peptide test the lab must know whether it was taken fasting or not fasting and what the blood glucose level was at the moment it was taken. In theory, a high fasting blood sugar with a high C-peptide value should point to Type 2 diabetes primarily caused by insulin resistance. That is because the high C-peptide value would suggest a lot of insulin was being produced but insulin resistance was keeping it from lowering blood sugar. In contrast, a C-peptide value that was normal or below normal taken at the same time as a high fasting glucose would suggest a form of Type 2 where failing beta cells rather than insulin resistance was the primary thing raising blood sugar. In theory, testing C-peptide very few years should also give you some idea of whether or not your beta cells are slowly failing.

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Normal or High C-Peptide test results may be Good News:

There is some recent research that suggests that C-peptide rather than being an inert by-product of insulin synthesis is, in fact, important for preventing diabetic complications. So any measure that prevents b-cell demise would in long run prevent diabetic complications.

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The following are some purposes of C-peptide testing:

•A C-peptide test is not ordered to help diagnose diabetes, but when a person has been newly diagnosed with diabetes, it may be ordered by itself or along with an insulin level to help determine how much insulin a person’s pancreas is still producing (endogenous insulin).

•In type 2 diabetes, the body is resistant to the effects of insulin (insulin resistance) and it compensates by producing and releasing more insulin, which can also lead to beta cell damage. Type 2 diabetics usually are treated with oral drugs to stimulate their body to make more insulin and/or to cause their cells to be more sensitive to the insulin that is already being made. Eventually, because of the beta cell damage, type 2 diabetics may make very little insulin and require injections. Any insulin that the body does make will be reflected in the C-peptide level; therefore, the C-peptide test can be used to monitor beta cell activity and capability over time and to help a health practitioner determine when to begin insulin treatment.

•People who are on insulin therapy, regardless of the source of the insulin, may develop antibodies to insulin. These typically interfere with tests for insulin, making it nearly impossible to directly evaluate endogenous insulin production. In these cases, C-peptide measurement is a useful alternative to testing for insulin.

•C-peptide measurements can also be used in conjunction with insulin and glucose levels to help diagnose the cause of documented hypoglycemia and to monitor its treatment.  Symptoms of hypoglycemia may be caused by excessive supplementation of insulin, alcohol consumption, inherited liver enzyme deficiencies, liver or kidney disease, or by insulinomas.

•The C-peptide test may be used to help diagnose Insulinomas. These are tumors of the islet cells in the pancreas that can produce uncontrolled amounts of insulin and C-peptide and can cause acute episodes of hypoglycemia. C-peptide tests may be used to monitor the effectiveness of insulinoma treatment and to detect recurrence.

•Sometimes a C-peptide test may be used to help evaluate a person diagnosed with metabolic syndrome, a set of risk factors that includes abdominal obesity, increased blood glucose and/or insulin resistance, unhealthy blood lipid levels, and high blood pressure (hypertension).

•Rarely, when someone has had his pancreas removed or has had pancreas islet cell transplants, intended to restore the ability to make insulin, C-peptide levels may be used to verify the effectiveness of treatment and continued success of the procedure.

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Postprandial C-peptide Index: The Best Marker of Beta Cell Function? 2014 study:

Authors have recently reported that postprandial serum C-peptide to plasma glucose ratio, called postprandial C-peptide index, was associated with the future need for insulin therapy. C-peptide is a well-established marker of beta cell function. C-peptide is split from insulin and co-secreted with insulin from beta cells at the same molar ratio. While ~50% of insulin is extracted by the liver, C-peptide is not extracted by the liver. Therefore, the measurement of C-peptide more directly reflects beta cell secretory rate compared with insulin, independent of hepatic clearance. Moreover, one of the advantages of C-peptide measurement in clinical settings is that C-peptide can be assessed in patients treated with insulin, which cross-reacts with the insulin measurement. In their study, interestingly, postprandial C-peptide index was superior for predicting the need for future insulin therapy compared with fasting C-peptide index or urinary C-peptide excretion. More recent studies have also confirmed their findings. It has also been reported that postprandial serum C-peptide, but neither fasting C-peptide nor urinary C-peptide, independently predicted successful switching from insulin therapy to liraglutide monotherapy, suggesting that postprandial C-peptide has the best ability to predict treatment efficacy among other C-peptide indices. The reason for this is unknown; however, several possibilities have been postulated. Postprandial C-peptide likely reflects maximal insulin secretion induced by a combination of postprandial hyperglycemia and incretin effects, compared with fasting C-peptide. Besser et al. have reported that in patients with T1DM, 90 min postprandial C-peptide value is highly correlated with peak C- peptide value and area under the curve (AUC) of C-peptide during a mixed-meal tolerance test, which is the gold-standard measure of endogenous insulin secretion in T1DM. Intriguingly, it has been reported that postprandial C-peptide index was more closely correlated with beta cell mass in humans compared with fasting C-peptide index. These results suggest that postprandial C-peptide reflects maximal beta cell functional capacity. Disposition index is a measure of beta cell function adjusted for insulin sensitivity, which reflects “true” beta cell function. Recently, it has been reported that postprandial C-peptide index, but not fasting measures such as fasting C-peptide index and homeostasis model assessment (HOMA)-β is significantly correlated with disposition index assessed by hyperglycemic and euglycemic clamp. The authors speculate that postprandial C-peptide index reflects systemic insulin sensitivity, i.e., mainly glucose disposal in peripheral tissues, whereas fasting C-peptide index or HOMA-β reflects hepatic insulin sensitivity.

Recently, the usefulness of postprandial urinary C-peptide creatinine ratio has also been proposed. It has been reported that postprandial urinary C-peptide creatinine ratio was highly correlated with C-peptide and insulin AUC during an oral glucose tolerance test (OGTT) in non-diabetic subjects. Thong et al. have reported that postprandial urinary C-peptide creatinine ratio weakly correlated with HbA1c change after liraglutide treatment. However, since in patients with chronic kidney disease (CKD), urinary C-peptide creatinine ratio di