Charak Samhita

Vyayama

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The Sanskrit word vyayama means specific activity. Generally, it denotes physical exercise which impart strength and firmness. [Cha. Sa. Sutra Sthana-7/31] Vyayama is benificial to healthy and unhealthy individuals, with an added clause of due caution and supervision. Vyayama in healthy people improves and maintains health: whereas, it is preventive as well as therapeutic tool for various diseases (e.g.: lifestyle disorders, joint dislocation etc.). In fact, vyayama is a cost-effective means for a disease-free generation. This chapter describes concept of vyayama and its application in healthcare management.
Contributors
Section/Chapter/topic Concepts/Vyayama
Authors Anupama Krishnan1,
Blessymol EV 2
Reviewer Basisht G.3
Editor Deole Y.S.4
Affiliations 1Associate Professor, Department of Swasthavritta, VPSV Ayurveda College, Kottakkal, Kerala, India
2Medical Content Writer,Smriti Meditation Practioner
3 Rheumatologist, Orlando, Florida, U.S.A.
4 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails dr.anupamakrishnan@gmail.com,
carakasamhita@gmail.com
Publisher Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication: January 05, 2023
DOI 10.47468/CSNE.2023.e01.s09.126

Importance

Vyayama is a desirable health behavior for primordial, primary, secondary and tertiary levels of prevention. Lack of vyayama is the major reason for lifestyle disorders/ non-communicable diseases and also paves way to the infectious diseases by hampering the immune power.
Vyayama includes all the exertional activities, which impart stretching of different body parts [Su.Sa.Chikitsa Sthana-11/11- Dalhana commentary]. Vyayama, is the best tool for improving firmness/ fitness [A.S.Sutra Sthana-13/2; Cha.Sa.Sutra Sthana-25/40], and is reflected as the ultimate for stability [A.H.Uttara Sthana-40/55]. In fact, it is the best way to get rid of obesity.[1]
However, vyayama endorses only the physical activities; thereby excluding mental and verbal exertion in this domain. [Cha.Sa.Sutra Sthana-7/31 Chakrapani]. Therefore, vyayama plays a vital role in preservation of health and management of disease.

Etymology and derivation

The nirukti (origin) of the term vyayama is Vi + Aa + Yam+ Ghan (वि+आ+यम+घञ् | पौरुषः) [Shabdakalpadrumam]. It means specific stretching.

Types 

Sushruta categorizes vyayama as physical (sharira), verbal (vak), and mental (manas). Su.Sa.Sutra Sthana- 35/40 Dalhana].

Features of optimal vyayama

Profuse sweating, increased respiration, feeling lightness of body and tightness in cardiac region are signs of optimal vyayama. [Cha.Sa.Sutra Sthana-7/32-33]
Vyayama is one among the best practices for preservation of health (ekanta pathyatama). [Su.Sa.Sutra Sthana-20/6] For a healthy person, right amount of vyayama at right time is wholesome. [Dalhana on Su.Sa. Sutra Sthana 20/6]
Extent of exercise is determined by one’s own capacity. One should stop exercise before getting tired. [Cha.Sa.Sutra Sthana-8/18] Strong persons, and those habituated to fat rich diet can daily practice vyayama up to half of their capacity in cold seasons like hemanta & shishira (winter), and in vasanta ritu (spring). During rest of the seasons, vyayama can be executed with mild to moderate strength. [A.H.Sutra Sthana-2/11-12] [Su.Sa.Chikitsa Sthana-24/45-46]
Vyayama shakti or strength of performing physical exercise is an important patient examination tool in Ayurveda. [Cha.Sa.Vimana Sthana 8/94] A healthy individual can withstand exercise or any physical activity [Cha.Sa.Sutra Sthana-21/18]. Whereas, lean or emaciated person is deprived of the ability to perform exercise [Cha.Sa.Sutra Sthana-21/13].

Amount of vyayama

One should practice vyayama at half his/her capacity (ardhashakti) which is denoted by sweating of axillae, temples, nose, joints coupled with dry mouth.[2] Other sign of ardhashakti vyayama is dislodgement of vata located in chest region to mouth. [Su.Sa.Chikitsa Sthana 24/47]

Benefits 

People who indulge in daily vyayama will be endowed with light, proportionate and compact body, increased appetite, reduced body fat, enthusiasm and endurance. [A.H.Sutra Sthana 2/11; Cha.Sa.Sutra Sthana-7/32] They can easily digest even the incompatible food. [A.H.Sutra Sthana-7/47; Cha.Sa.Sutra Sthana 5/6; Cha.Sa.Sutra Sthana-26/106]. Vyayama relieves sleepiness [Cha.Sa.Sutra Sthana-21/55-57]. And wedges the tri-dosha (basic bodily humors) from koshtha / central body to shakha/ peripheral body. [A.H.Sutra Sthana-13/17; A.S.Sutra Sthana-19/23; Cha.Sa.Sutra Sthana-28/31]
Kleda (moisture or interstitial fluid) does not accumulate in tissues by virtue of regular exercise. [A.S.Sutra Sthana-11/56; Cha.Sa.Chikitsa Sthana-15/239] Obesity can be checked by regular vyayama as it endows well-built musculature to the person. [Su.Sa.Chikitsa Sthana-24/39-42] Well-built compact physique, charming appearance, and tolerance to cold/ heat/ hunger/ thirst are the revered qualities .The exercise generated robust digestive fire can properly digest food items even if they are incompatible, heavy to digest and causing burning sensation in stomach.[3]

Recommendations for those who practice daily vyayama

Oleation therapy is beneficial, for those who are accustomed to regular exercise. [Cha.Sa.Sutra Sthana-13/52; A.S.Sutra Sthana-25/9; A.H.Sutra Sthana-16/5] Vasa (animal fat) and majja (bone marrow) are the ideal materials for this. [Cha.Sa.Sutra Sthana-13/16; A.S.Sutra Sthana-25/11; A.H.Sutra Sthana-16/10-11]. Anuvasana basti (Unctuous enema) with lipid formulation of drugs, on a daily basis is also recommended. [A.H.Sutra Sthana-19/34; A.S.Sutra Sthana-27/34; Cha.Sa.Siddhi Sthana-4/23]. Vyayama without prior oil massage causing vatika gulma (development of abnormal masses), due to vata reinforces this schedule. [Cha.Sa.Chikitsa Sthana-5/21] Nasya (nasal instillation of medicine) to be given after vyayama as it relieves fatigue, arduousness, sweat and stiffness [A.S.Sutra Sthana-29/21] and pratimarsha nasya (nasya at a smaller dose) after vyayama alleviates fatigue. [Su.Sa.Chikitsa Sthana-40/52] One who is fond of vyayama is eligible for matra basti (retention of small dose of lipid formulation of medicine) in rectum always. [A.H.Sutra Sthana 19/68; A.S.Sutra Sthana-28/8; Cha.Sa.Siddhi Sthana-4/5]

Post- vyayama procedures

Whole body oil massage following vyayama, increases the exercise endurance. [Cha. Sa. Sutra Sthana-5/86] After performing vyayama, one should gently massage the whole body. [A.H.Sutra Sthana-2/13; Su.Sa.Chikitsa Sthana-24/38] Powder massage of feet after exercise prevents diseases and offers appealing looks, which can surpass age. [Su.Sa.Chikitsa Sthana-24/43-44]

Forbidden activities/ behaviors after vyayama

Strenuous physical activities after vyayama is harmful to health. [Cha.Sa.Sutra Sthana-8/22] Person who consumes alcohol after indulging in vyayama succumbs to health hazards. [Madhava Nidana-18/13] Therapeutic emesis (vamana) [A.S.Sutra Sthana-27/6; Cha.Sa.Siddhi Sthana-2/8] and Nasal administration (nasya) [Cha.Sa.Siddhi Sthana-2/20] are contraindicated for those who are exhausted by vyayama.

Indications 

Vyayama is indicated for healthy individual (swastha) [Cha.Sa.Sutra Sthana-30/8], strong person with good immunity (balavan) [Su.Sa.Chikitsa Sthana-25/51], people who are accustomed to unctuous diet (snigdhabhoji) [Su.Sa.Chikitsa Sthana-25/51], person with excess kapha and fat deposition in body (kapha medanvita) [Su.Sa.Chikitsa Sthana-32/15]; health issues like diabetes (prameha) [Su.Sa.Chikitsa Sthana-11/11; Cha.Sa.Chikitsa Sthana-6/61] and obesity (sthaulya) [Cha.Sa.Sutra Sthana-23/25; Su.Sa.Sutra Sthana-15/32]; and in winter (hemanta and shishira ritu) [A.S.Sutra Sthana-4/10-13], as well as spring season (vasanta rtu) [A.H.Sutra Sthana-3/11; Cha.Sa.Sutra Sthana-6/24]. Vyayama is most conducive in winter and spring season. [Su.Sa.Chikitsa Sthana-24/46]

Contra indications

Seasons:

Physiological:

  • Soon after having food [A.H.Sutra Sthana-2/11; Su.Sa.Chikitsa sthana-24/50-51]
  • Exhausted by other physical activities- [Su.Sa.Chikitsa Sthana-24/49-51],
  • After coitus [Su.Sa.Chikitsa Sthana-24/50-51]
  • Feeling thirsty [Cha.Sa.Sutra Sthana-7/35; Su.Sa.Chikitsa Sthana-24/50-51]
  • Feeling hungry [Cha.Sa.Sutra Sthana-7/35]
  • Pregnancy [Cha.Sa.Sutra Sthana-25/40]
  • Small children [A.H.Sutra Sthana-2/11; Cha.Sa.Sutra Sthana-7/35]
  • Old people [A.H.Sutra Sthana-2/11; Cha.Sa.Sutra Sthana-7/35]
  • Person having more natural or vitiated vata dosha [Cha.Sa.Sutra Sthana-7/35]
  • Persons who are talkative or speaking loudly [Cha.Sa.Sutra Sthana-7/35]
  • Exhausted by walking, weight lifting, coitus etc. [Cha.Sa.Sutra Sthana-7/35]
    • Psychological:
    • Persons who are desirous of increasing body weight. [Cha.Sa.Sutra Sthana-21/28]
    • Those who are angry, sad or scared [Cha.Sa.Sutra Sthana-7/35]

Pathological:

  • Diseases due to vata and pitta [A.H.Sutra Sthana-2/11]
  • Bleeding disorders (raktapitta) [Su.Sa. Chikitsa Sthana-24/50-51]
  • Breathing disorders (shwasa) [Su.Sa.Chikitsa Sthana-24/50-51]
  • Cough (kasa) [Su.Sa.Chikitsa Sthana-24/50-51]
  • Chest injury (urakshata) [Su.Sa.Chikitsa Sthana-24/49-51]
  • Emaciation (shosha) [Su.Sa.Chikitsa Sthana-24/50-51]
  • Lean person (karshya) [Su.Sa.Sutra Sthana-15/33; Su.Sa.Chikitsa Sthana-25/50-51]
  • Disorders of abdomen (udara) [Cha.Sa.Chikitsa Sthana-13/17; Cha.Sa.Chikitsa Sthana-13/100] Vertigo/ giddiness (bhrama) [Su.Sa.Chikitsa Sthana-24/50-51]
  • Skin eruptions (visarpa) [Cha.Sa.Chikitsa sthana-21/115]
  • Fractures (bhagna) [A.S.Uttara Sthana-32/38; Su.Sa.Chikitsa Sthana-3/4; 3/25]
  • Arthritis (vatashonita) [Su.Sa.Chikitsa Sthana-5/17]
  • Enlargement of bodily organs (vruddhi) [Su.Sa.Chikitsa Sthana-19/2-3]
  • Urinary calculi (ashmari) [Cha.Sa.Chikitsa Sthana-26/76]
  • Rhinitis by aggravated vata (vatika pinasa) [Cha.Sa.Chikitsa Sthana-26/143]
  • Ear diseases (karna roga) [Su.Sa.Uttara Tantra-21/3]
  • Poisoning (vishabadha) [Su.Sa.Kalpa Sthana-6/31]
  • Acute fever (taruna/nava jwara) [Su.Sa.Uttara Tantra- 39/156-157; Cha.Sa.Chikitsa Sthana-3/138-139].
  • In ulcer (vrana) up to 6 to 7 months [A.S.Sutra Sthana38/41; Su.Sa.Sutra Sthana-19/20; Su.Sa.Sutra Sthana 5/39]

Vyayama is forbidden in all above conditions, and if this is violated it will agitate the condition or delay wound healing. [Su.Sa.Sutra Sthana-23/21]

Convalescence :

Following treatments like purgation therapy (virechana) [Sha.Sa.Uttara Khanda-4, p340], oral administration of lipid formulation of drugs (snehapana) [Cha.Sa.Sutra Sthana- 13/63; Cha.Sa.Sutra Sthana-14/67; A.S.Sutra Sthana-25/31], and sudation therapy (swedana) [Cha.Sa.Sutra Sthana-14/67; A.S.Sutra Sthana-26/24]; before regaining strength after purificatory therapies (panchakarma) (Su.Sa.Shareera Sthana-8/24]; prior to attaining complete strength after the relief of fever (jwaramukta) [Cha.Ci-3/332; Su..Ut-39/160; A.S.Ni-2/76], and for 1 year after healing fissure-in-ano (bhagandara) [Su..Ci-8/14] vyayama is contraindicated.

Precautions of vyayama

Vyayama shall be performed after considering variables like age, strength, body constitution, geography, seasons and diet pattern. [Su.Sa.Chikitsa Sthana 24/48]
Vyayama soon after food consumption causes rheumatoid arthritis (amavata). [Madhava Nidana 25/1]
Vyayama shall not be done before proper digestion of food [A.Hr.Sutra Sthana 2/11] as it precipitates skin diseases (kushtha) [Cha.Sa.Nidana Sthana5/6; Su Sa.Nidana Sthana-5/3; M.Ni-41/2; Cha.Sa Chikitsa Sthana.7/5]
Over exertion in outdoor settings may manifest as fever (jwara), hence conducive and comfortable climatic conditions are necessary for vyayama. [A.S.Nidana Sthana 2/58]

Concept of ativyayama

Ativyayama refers to bodily exertion beyond the recommended limits. Over exertion undisputedly destroys the body just like the lion who tried to defeat an elephant attacking directly. [A.H.Sutra Sthana-2/15; Cha.Sa Sutra Sthana7/35] It also results in aggravation of vata [A.H. Nidana Sthana 1/15] especially prana vayu [A.H.Nidana Sthana16/19; A.S.Nidana Sthana 16/17]; and aggravation of pitta [A.H.Nidana Sthana -9/35]. Chronic over-exertion will manifest as chest injury (urakshata) even without any external trauma. [Ma.Ni.10/19]
Care should be taken, to abstain from over-exertion [Cha.Sa.Sutra Sthana-7/34] as it will eventually reduce the quality of semen/ ovum (shukra) [Cha.Sa Chikitsa Sthana30/135-139], which is reflected as extreme tiredness, lack of enthusiasm, weakness to perform all physical and mental activities, breathing difficulties and higher brain faculty derangement. [A.S.Uttara Sthana 49/5; Cha.Sa Chikitsa Sthana2/3] Hence, a wise person should always abstain from over-exertion. [Cha.Sa Sutra Sthana-7/34] Those vanquished by vyayama are eligible for oleation (snehana) therapy. [A.H.Sutra Sthana 16/5; Cha.Sa Sutra Sthana13/52]

Complications of ativyayama

Excessive thirst (thrishna), emaciation (kshaya), dyspnoea with fever and fainting (pratamaka), bleeding disorders (raktapitta), fatigue (shrama), lethargy (klama), severe cough (kasa), fever (jwara), and vomiting (chardi) are caused due to excess vyayama. [A.H.Sutra Sthana2/14; A.S.Sutra Sthana3/364].
Other health issues, in which over-exertion is the patho-physiological factor are hiccups (hikka shwasa) [Su.Sa.Uttara Tantar 50/3-4; Cha.Sa.Chikitsa Sthana 17/11; M.Ni12/1-2], especially that develop soon after food intake (kshudra hikka) [Cha.Sa.Chikitsa Sthana17/34]; cough (kasa) [Su.Sa.Uttara Tantra 52/4, M.Ni11/1; A.H.Sutra Sthana 2/14; A.S.Sutra Sthana 3/64-65], anaemia (pandu) [Cha.Sa.Chikitsa Sthana 16/8; M.Ni 8/2], obstructive jaundice (shakhashrita kamala) [Cha.Sa.Sutra Sthana16/125], bleeding disorders (raktapitta) [A.S.Sutra Sthana-3/64-65; M.Ni 9/1], chest infections including tuberculosis (rajayakshma) [M.Ni 10/14], emaciation (shosha) [M.Ni 10/19], neurological and musculo-skeletal disorders (vatavyadhi) [Cha.Sa.Chikitsa Sthana 28/16-19; M. Ni 22/2], arthritis (vatarakta) [Su.Sa.Nidana Sthana-1/40-41], dysuria (mutrakrichra) [M.Ni 30/1; Cha.Sa.Chikitsa Sthana 26/32], burning sensation while urinating (ushnavata) [Su.Sa.Uttara Tantra 58/22-23; M.Ni- 31/25], obstructed blood vessels (siragranthi) [Su.Sa.Nidana Sthana 11/8; A.H.Uttara Sthana 29/10; A.S.Uttara Sthana 34/11; M.Ni38/16], chest injury without external trauma (urakshata) [Cha.Sa.Nidana Sthana- 6/4), abdominal colic (shula roga) [M.Ni 26/2), suppuration of intestinal organs (antravidradhi) [Su.Sa.Nidana Sthana-9/16], headache over one side (ardhavabhedaka) [M.Ni60/11], polyp in female reproductive organ (yonikanda) [Ma..Ni 63/1], internal lumps due to vata (vataja gulma) [Cha.Sa.Nidana Sthana-3/6], haemorrhoids due to vata (vatika arsha) [Cha.Sa.Chikitsa Sthana-14/13; M. Ni3/34; 5/4) and pitta (pitta dominant arsha) [Madhava Nidana-5/5], cardiac disease due to vata (vata dominant hridroga) [Cha.Sa. Suta Sthana- 17/30; Cha.Sa.Chikita Sthana- 26/77], diarrhoea due to vata (vatika atisara) [Cha.Sa.Chikitsa Sthana 19/5], vomiting due to vata (vata dominant cchardi) [Cha.Sa.Chikitsa Sthana- 20/7], appearance of lipid in urine (vasa meha) [Cha.Sa.Nidana Sthana 4/36]. Ativyayama causes trauma in the thoracic region and it will result in traumatic cough (kshataja kasa). [Su.Sa.Uttara Tantra 52/11]
By over exertion, the end-product of digestion/chyle (rasa dhatu) dries up and reduces its quality. Thus the person will become lean. [Su.Sa. Sutra Sthana 15/33]

Concept of avyayama

Avyayama is the lack/ reduced physical exertion yielding in aggravation of kapha dosha [Cha.Sa Nidana Sthana 1/25] and vitiation of channels of transportation of lipids (medovaha srotodushi). [Cha.Sa.Vimana Sthana -5/16]
The condition is encountered in diseases due to deranged lipids (medoroga) [Ma.Ni 34/1], obesity (atisthaulya) [Cha.Sa.Sutra Sthana 21/4; Su.Sa.Sutra Sthana-15/32], obstinate urinary diseases including diabetes (prameha) [Su.Sa.Nidana Sthana 6/3], diabetes due to kapha (kaphaja prameha) [Cha.Sa Nidana Sthana-4/5], chronic stage of diabetes with aggravated vata (madhumeha) [Cha.Sa.Sutra Sthana 17/79-80], worm- infestation (krimiroga) [Su.Sa.Uttara Tantra 54/3; M. Ni7/4], oedema due to kapha (kapha dominant shopha) [Cha.Sa.Sutra Sthana18/7-8], abdominal disorders due to kapha (kaphaja udara) [Cha.Sa.Chikitsa Sthana 13/29], hemorrhoids due to kapha (kaphaja arsha) [Cha.Sa. Chikitsa Sthana 14/18-19; Ma.Ni 5/7], and a type of erysipelas (granthi visarpa). [Cha. Sa. Chikitsa Sthana 21/39]

Contemporary approach

Difference between physical exercise and vyayama:

The WHO definition of physical activity is any bodily movement produced by skeletal muscles that requires energy expenditure[4]. It can be household work, moving from one place to other, lifting an object etc. Exercise is a subcategory of physical activity that is planned, structured, repetitive, and purposefully focused on improvement or maintenance of one or more components of physical fitness[5]. Vyayama is of three types- physical, verbal or mental, among them only physical exercise is meant for health maintenance, and it must be implemented at right amounts, with due precautions. Mental exertion has a tiring effect and therefore it cannot be considered as a healthy practice.[6] Vyayama is an anabolic/ constructive activity as per Ayurveda, with benefits like ability to perform activities, increased digestion, reduction of unwanted fat deposits, fitness etc. It is recommended to be practiced, along with an adequate lipid diet in moderate quantity, and therefore burn-out is not a goal of vyayama. Hence, it is a conducive physical exertion. There is a clear-cut difference between vyayama, ayasa (exertion) and shrama (fatigue), where the latter two are catabolic in nature, which results in exhaustion and burn-out. Both these are dangerous to health. On the other hand, vyayama should be stopped prior to exhaustion.

Types of exercise:

There are mainly four types of exercises namely:
a) Endurance, strength, balance and flexibility[7]. Endurance exercises otherwise known as aerobic exercises, improve heart rate and respiratory rate. They help in preventing diseases due to wear and tear. Swimming, dancing, brisk walking etc. are some examples of endurance exercises. Strengthening exercises increase muscle strength, prevent falls and improve body balance. They include weight training, wall push-ups, lifting the body weight etc. Balance exercises enhance body balance and thereby prevent falls (eg: yoga, heel to toe walking). Flexibility exercises are stretching itself.
Over-exertion (ativyayama): Magnitude and duration of exercise are to be determined prior to designing the schedule considering the physique, age, health status, amount of physical activity etc. In order to gain a fascinating physical appearance in a short period many people, especially celebrities follow unhealthy aggressive exercise protocol. Recent alarming events, of celebrity death in their 40’s and 50’s point towards the illogical unhealthy exercise schedule.
Contemporary approach: Exercise and work-out has become a part of a popular lifestyle measure in addition of being health promotion tool. Group exercises like dance, zumba etc. are mainly meant for fun gathering methods. Intention of such activities are relaxation, shaping the body, and in most cases, an a lacunae surfaces in an analytical approach in implementing these activities based on the individual’s needs. Additionally, self-exercise/ work-out, using social media is very common which also shares, the same drawback.
Personalization of exercise: Physique, physical activity, age, dietary intake, etc. of each individual is variable, so exercise must be designed in accordance with the needs of the person.
Combined effect of diet and exercise: In order to achieve fitness and health, diet restriction or exercise alone is not very beneficial. Combined and wise execution of these two are the key to achieve the expected results[8][9]. Vyayama is hence, included in daily regimen (dinacharya) with an optimal magnitude.
Role of prajna and prajnaparadha in exercise adherence: Awareness regarding one’s health status, bad habits, health behavior (dhi) are the key for initiating action- (dhriti). Both these bring forth enthusiasm and endurance towards exercise (maintenance/ adherence). When the individual lacks enthusiasm (dhriti bhramsha/ prajnaparadha), the adherence to exercise fades. Thus, continuous loop of prajna installation and prajnaparadha installation (relapse) play in cyclical adherence and non-adherence to exercise, which is the core theme behind ‘dushchikitsya atisthoola’ concept.
Fit India Movement: An Indian government initiative aimed at improving the health of citizens by daily exercise. It was launched on the National sports day 2019 (August 29). It includes age appropriate fitness protocol for 5-18 years, 18-65 years and above 65.

Current researches

Therapeutic exercise

  • Systematic regular exercise can improve cognitive function and memory. [10].
  • Exercise can be used as a tool for primary prevention in the past phase (before the onset), secondary prevention (in present cases) and prognosis of heart failure. [11].
  • Regular aerobic exercise can decrease the depressive symptoms and thereby the pro-inflammatory IL6. [12].
  • A study recommends that hypertensive individuals should aim to perform moderate intensity aerobic exercise activity for at least 30 minutes on most (preferably all) days of the week in addition to resistance exercises on 2–3 days/week. [13].
  • Studies show that there is no improvement in Hba1c with high dose of exercise. [14]
  • Low amount of moderate intensity exercise combined with diet is the most effective intervention for improving health-related quality of life. Also, low amount of moderate intensity exercise provides the greatest impact on mental well- being. [15].
  • Chronic exposure to exercise in obese children and adolescents shows increase in heart rate, parasympathetic activity and sympathetic-vagal balance. [16].
  • Voluntary exercise helps in the influx of immune cells in tumors, and reduction in tumor incidence and growth among mouse models. [17].
  • Aerobic exercise is the best tool for treating Parkinson's disease [18].
  • Physical exercise can be used as an alternative to antidepressants in older adults [19].

Mental exertion

  • Mental exertion is a psychophysiological state caused by sustained and prolonged cognitive activity. The activities/ occupations that demand physical exertion will have a hampering influence by prior mental exertion. [6].

Exercise diet

  • Plant protein can also enhance resting muscle protein synthesis (MPS). Plant protein containing essential amino acids especially leucine facilitates prolonged adaptations to exercise training similar to animal protein. [20].

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References

  1. ↑ Rajavallabha Nighantu; Chapter 2; sloka 12; NIIMH-National Institute of Indian Medical Heritage. e-Samhita [Internet]. Available from: http://niimh.nic.in.
  2. ↑ Kaiyadeva Nighantu; Chapter 8; sloka 153; NIIMH-National Institute of Indian Medical Heritage. e-Samhita [Internet]. Available from: http://niimh.nic.in.
  3. ↑ Kaiyadeva Nighantu; Chapter 8; sloka 246-248; NIIMH-National Institute of Indian Medical Heritage. e-Samhita [Internet]. Available from: http://niimh.nic.in.
  4. ↑ WHO. Physical activity [Internet]. 2022 [cited 2022 Dec 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity
  5. ↑ Dasso NA. How is exercise different from physical activity? A concept analysis. Nurs Forum [Internet]. 2019 Jan 1 [cited 2022 Dec 14];54(1):45–52. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/nuf.12296
  6. ↑ 6.0 6.1 Silva-Júnior FL e, Emanuel P, Sousa J, Silva M, Teixeira S, Oliveira Pires F, et al. Prior Acute Mental Exertion in Exercise and Sport. Clin Pract Epidemiol Ment Heal. 2016;12(1):94–107.
  7. ↑ NIH. Four Types of Exercise Can Improve Your Health and Physical Ability | National Institute on Aging [Internet]. National Institute on Aging NIA. 2021 [cited 2022 Dec 14]. Available from: https://www.nia.nih.gov/health/four-types-exercise-can-improve-your-health-and-physical-ability
  8. ↑ Magkos F, Hjorth MF, Astrup A. Diet and exercise in the prevention and treatment of type 2 diabetes mellitus. Nat Rev Endocrinol. 2020 Oct;16(10):545-555. doi: 10.1038/s41574-020-0381-5. Epub 2020 Jul 20. PMID: 32690918.
  9. ↑ Johns DJ, Hartmann-Boyce J, Jebb SA, Aveyard P; Behavioural Weight Management Review Group. Diet or exercise interventions vs combined behavioral weight management programs: a systematic review and meta-analysis of direct comparisons. J Acad Nutr Diet. 2014 Oct;114(10):1557-68. doi: 10.1016/j.jand.2014.07.005. PMID: 25257365; PMCID: PMC4180002.
  10. ↑ Ptomey LT, Szabo AN, Willis EA, Gorczyca AM, Greene JL, Danon JC, et al. Changes in cognitive function after a 12-week exercise intervention in adults with Down syndrome. Disabil Heal J. 2019;11(3):486–90.
  11. ↑ Cattadori G, Segurini C, Picozzi A, Padeletti L, Anzà C. Exercise and heart failure: an update. ESC Hear Fail. 2018;5(2):222–32.
  12. ↑ Ventura J, McEwen S, Subotnik K, Hellemann G, Ghadiali M, Rahimdel A, et al. Changes in inflammation are related to depression and amount of aerobic exercise in first episode schizophrenia. Early Interv Psychiatry. 2021;15(1):213–6.
  13. ↑ Sharman JE, La Gerche A, Coombes JS. Exercise and cardiovascular risk in patients with hypertension. Am J Hypertens. 2015;28(2):147–58.
  14. ↑ Wrench E, Rattley K, Lambert JE, Killick R, Hayes LD, Lauder RM, et al. There is no dose–response relationship between the amount of exercise and improvement in HbA1c in interventions over 12 weeks in patients with type 2 diabetes: a meta-analysis and meta- regression. Acta Diabetol [Internet]. 2022;59(11):1399–415. Available from: https://doi.org/10.1007/s00592-022-01918-8.
  15. ↑ Collins KA, Ross LM, Piner LW, Fos LB, Slentz CA, Bateman LA, et al. Amount and intensity effects of exercise training alone versus a combined diet and exercise lifestyle intervention on health-related quality of life in the STRRIDE-PD randomized trial. BMJ Open Diabetes Res Care. 2022;10(1):1–10.
  16. ↑ Dias RM, Moraes ÍAP, Dantas MTAP, Fernani DCGL, Fontes AMGG, Silveira AC, et al. Influence of chronic exposure to exercise on heart rate variability in children and adolescents affected by obesity: A systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(21):1–14.
  17. ↑ Idorn M, thor Straten P. Exercise and cancer: from “healthy” to “therapeutic”? Cancer Immunol Immunother. 2017;66(5):667–71.
  18. ↑ Alberts JL, Rosenfeldt AB. The Universal Prescription for Parkinson’s Disease: Exercise. J Parkinsons Dis. 2020;10(s1):S21–7.
  19. ↑ López-Torres Hidalgo J, Aguilar Salmerón L, Boix Gras C, Campos Rosa M, Escobar Rabadán F, Escolano Vizcaíno C, et al. Effectiveness of physical exercise in the treatment of depression in older adults as an alternative to antidepressant drugs in primary care. BMC Psychiatry. 2019;19(1):1–7.
  20. ↑ Kerksick CM, Jagim A, Hagele A, Jäger R. Plant proteins and exercise: What role can plant proteins have in promoting adaptations to exercise? Nutrients. 2021;13(6):1–22.
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