Physical activity is any bodily movement produced by skeletal muscles that requires energy expenditure above resting levels. Physical fitness refers to the ability to perform physical activities without undue fatigue and is achieved through a combination of proper nutrition, regular moderate-to-vigorous physical activity, and adequate rest. Regular physical activity is a key component of health promotion and the prevention and management of non-communicable diseases. It improves insulin sensitivity, reduces glycated haemoglobin (HbA1c) by approximately 0.7% in people with type 2 diabetes mellitus, lowers blood pressure, improves lipid profiles, assists in maintaining a healthy body weight, and reduces the risk of cardiovascular disease and type 2 diabetes.

Benefits of physical activity

Regular physical activity:

• Improves insulin sensitivity and reduces insulin resistance.

• Lowers HbA1c by approximately 0.7% in people with type 2 diabetes mellitus.

• Reduces the risk of developing type 2 diabetes mellitus.

• Improves lipid profile.

• Lowers blood pressure.

• Helps maintain a healthy body weight.

• Improves cardiorespiratory fitness.

• Increases muscle strength and endurance.

• Improves flexibility and balance.

• Reduces the risk of falls in older adults.

• Improves mental health and overall quality of life.

Types of physical activity

Physical activity includes all movements requiring skeletal muscle contraction and increased energy expenditure above resting levels.

Examples include:

Occupational activities

Activities performed during work, such as:

• Walking

• Carrying loads

• Lifting

• Pushing

• Carpentry

• Farming

• Digging

• Shovelling

• Packing boxes

Leisure-time activities

Activities performed during free time, including:

• Structured exercise

• Walking

• Hiking

• Gardening

• Dancing

• Recreational sports

Aerobic activities

Aerobic exercise improves body composition, cardiovascular fitness, and respiratory endurance.

Examples include:

• Brisk walking

• Stair climbing

• Cycling

• Swimming

• Dancing

• Jogging

• Running

• Washing windows

• Washing cars

• Sweeping floors

• Vacuuming

• Mopping

• Digging

• Shovelling

• Carrying heavy loads

• Badminton

• Golf

• Tennis

• Volleyball

• Basketball

• Football

• Jumping rope

• Jumping jacks

For optimal benefit:

• Perform moderate-intensity activity, during which a person can talk but cannot sing.

• Alternatively, perform vigorous-intensity activity, during which speaking more than a few words without pausing for breath is difficult.

• Exercise for at least 30 minutes per day on at least five days per week.

Muscle-strengthening activities

Muscle-strengthening exercises improve muscle mass, strength, endurance, and functional capacity by working the major muscle groups, including the legs, hips, back, chest, abdomen, shoulders, and arms.

Examples include:

• Pull-downs

• Pull-ups

• Push-ups

• Dips

• Abdominal crunches or curl-ups

• Calf raises

• Jumping exercises

• Carrying heavy loads

• Heavy gardening such as digging or hoeing

For optimal benefit:

• Perform at least 8 repetitions of each exercise.

• Exercise each major muscle group on at least two days each week.

Stretching activities

Stretching exercises improve flexibility and increase the range of motion of joints.

Examples include:

• Neck flexion exercises

• Arm rotations

• Trunk rotations

• Muscle stretching exercises

Regular stretching helps improve mobility and daily functional activities such as bending to tie shoelaces.

Coordination activities

Coordination exercises improve neuromuscular fitness, balance, agility, and proprioception, thereby reducing the risk of falls, particularly among older adults.

Examples include:

• Standing on the toes of one leg

• Balance exercises

Assessment and promotion of physical activity

As part of routine prevention and management of non-communicable diseases, the physical activity level of every patient attending a health facility should be assessed. Healthcare providers should offer brief counselling on recommended levels of physical activity and encourage patients to adopt and maintain regular exercise appropriate for their age, physical condition, and underlying medical conditions.

Contraindications and precautions

Exercise programmes should be individualized for patients with chronic illnesses or physical limitations. Patients with unstable cardiovascular disease, severe musculoskeletal disorders, acute illness, or other conditions that may limit exercise should undergo appropriate medical assessment before initiating vigorous physical activity.

Complications of physical inactivity

Physical inactivity increases the risk of:

• Type 2 diabetes mellitus

• Hypertension

• Dyslipidaemia

• Coronary artery disease

• Stroke

• Obesity

• Osteoporosis

• Sarcopenia

• Depression and anxiety

• Reduced physical function

• Premature mortality

Prognosis

Individuals who engage in regular physical activity experience significant improvements in cardiovascular health, metabolic control, physical fitness, functional capacity, and quality of life. Long-term adherence to recommended exercise levels reduces the risk of chronic diseases, disability, and premature death.

Prevention

• Encourage regular physical activity throughout life.

• Promote active transportation such as walking and cycling where feasible.

• Reduce prolonged sitting and sedentary behaviour.

• Incorporate aerobic, muscle-strengthening, stretching, and coordination exercises into weekly routines.

• Assess physical activity routinely during healthcare visits and provide individualized counselling.