Long-term use of statins can exacerbate the risk of developing Type 2 diabetes

Long-term use of statins can exacerbate the risk of developing Type 2 diabetes

Healthy diet and lifestyle changes can prevent complications

New Delhi, 10 December 2017:A recent study has indicated that those indulging in the long-term use of cholesterol-lowering drug, statin, are at 30% more at risk of developing Type-2 diabetes. It mentions that taking statin is associated with a 36% heightened risk of subsequently being diagnosed with Type-2 diabetes. Research also indicates that statins may impair the production of insulin, the hormone needed to lower the body’s levels of blood glucose.

Estimates place the number of people living with diabetes at 60 million in India, of which 95% have Type 2 diabetes. Type 2 diabetes is typically brought on by poor eating habits, too much weight and too little exercise. This condition, when poorly controlled, can increase the risk of cardiovascular disease, blindness, and even kidney failure.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “In a person with Type 2 diabetes, the body does not utilize insulin properly and this condition is called as insulin resistance. The pancreas first makes extra insulin to make up for this. However, over time, it cannot make enough to keep the blood glucose at normal levels. While the exact trigger for this condition is not known, Type 2 diabetes could be a result of a combination of factors. Some may be genetically predisposed to the condition. People with a family history of obesity are also at an increased risk of developing insulin resistance and diabetes. Those who are obese have added pressure on their body’s ability to use insulin in controlling blood sugar levels. This can lead to Type 2 diabetes. The more fatty tissue a person has, the more resistant their cells become to insulin. Lifestyle factors also have a major role to play.”

The symptoms of Type 2 diabetes develop slowly, over a period of time. Some of them include increased thirst and hunger, frequent urination, weight loss, fatigue, blurred vision, slow healing of infections and wounds, and skin darkening in certain areas.

Adding further, Dr Aggarwal, said, “A healthy diet is, more expensive than an unhealthy one. The wide availability of cheap energy dense low-nutrient food is contributing to the global epidemic of type 2 diabetes. Foods which reduce the risk of type 2 diabetes such as vegetables, fresh fruit, whole grains and unsaturated fats need to be more affordable and more widely available.”

The following preventive measures can help prevent the onset of Type 2 diabetes in people.

·          Exercise more Exercise has various benefits including preventing weight gain, controlling blood sugar levels, and other conditions. A minimum of 30 minutes of physical activity every day is very beneficial.

·          Eat healthy A diet rich in whole grain, fruits, and vegetables is very good for the body. Fibrous food will ensure that you feel fuller for a longer period and prevent any cravings. Avoid processed and refined food as much as possible.

·          Limit your alcohol intake and quit smoking Too much alcohol leads to weight gain and can increase your blood pressure and triglyceride levels. Men should limit drinks to two per day and women to one per day. Smokers are twice as likely to develop diabetes as non-smokers and therefore, it is a good idea to quit this habit.

·          Understand your risk factors Doing so can help you in taking preventive measures at the earliest and avoid complications.

Heartburn and indigestion pills can increase kidney failure risk

Heartburn and indigestion pills can increase kidney failure risk

Medication should be avoided unless advised by the doctor and is necessary

New Delhi, 26 November 2017: Popping common heartburn and indigestion pills can increase the risk of kidney failure, if recent studies are to be believed. The study found that individuals who used proton pump inhibitors (PPIs), which reduce gastric acid production, had a 33% increased relative risk of developing chronic kidney disease (CKD) or kidney failure when compared with non-users. The IMA further advises that it is best to avoid medication unless necessary and advised by the doctor.

Chronic kidney disease can strike any one. Diabetes and high blood pressure are the two leading causes. Other risk factors for kidney disease include heart disease and a family history of kidney failure—a severe form of kidney disease.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President, Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon Honorary Secretary General IMA, in a joint statement, said, “AGFR below 60 is a sign of chronic kidney disease. A GFR below 15 is described as kidney failure. Without treatment, kidney disease often gets worse. If the GFR drops below 15, a person may feel tired and weak, with nausea, vomiting, and itching. At this point, one may need a kidney transplant or dialysis. Optimal hydration is the key to maintaining good kidney health. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body, which in turn, results in a significantly lower risk” of developing chronic kidney disease. CKD is also associated with metabolic disorders and bone disease and is an important risk factor for peripheral vascular diseases, cardiovascular disease and stroke.”

Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. As the kidneys are highly adaptable and able to compensate for lost function, signs and symptoms may not appear until irreversible damage has occurred.

Adding further, Dr Aggarwal, said, “CKD can be diagnosed using blood and urine tests. These tests are used to look for high levels of certain substances in your blood and urine that are signs your kidneys aren't working properly.”

The 8 Golden Rules to avoid or delay reaching the point of kidney failure.

·   Keep fit and active as it can help reduce your blood pressure.

·   Keep regular control of your blood sugar level as about half of people who have diabetes develop kidney damage.

·   Eat healthy and keep your weight in check as this can help prevent diabetes, heart disease and other conditions associated with chronic kidney disease (CKD).  Reduce your salt intake.

·   Maintain a healthy fluid intake. Traditional wisdom has long suggested drinking 1.5 to 2 liters (3 to 4 pints) of water per day. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing chronic kidney disease. 

·   Do not smoke as it slows the flow of blood to the kidneys. Smoking also increases the risk of kidney cancer by about 50%.

·   Do not take over-the-counter pills on a regular basis: drugs like ibuprofen are known to cause kidney damage and disease if taken regularly.

Breastfeeding may cut the risk of SIDS

Breastfeeding may cut the risk of SIDS

Breastfeeding has multiple other benefits including improvement in immunity and the mother’s wellbeing

New Delhi, 31 October 2017: Evidence from a recent research has suggested that babies who are exclusively breastfed for at least two months stand a lesser chance of Sudden Infant Death Syndrome (SIDS).The risk is cut by almost half, the study finds. Breastfeeding has also earlier been suggested to cut the risk of asthma and benefit the mother’s wellbeing. There are ongoing efforts worldwide to improve the rates of breastfeeding, and the WHO has the goal of having more than half of infants worldwide being breastfed exclusively for at least six months by 2025.

SIDS refers to the unexplained death, usually during sleep, of a seemingly healthy baby less than a year old. It is also known as crib death because the infants often die in their cribs. Among others, few reasons for SIDS include defects in the portion of an infant's brain that controls breathing and arousal from sleep.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Although SIDS is the leading cause of death among infants between 1 month and 1 year, it remains unpredictable despite years of research. SIDS is more likely in babies placed on their stomachs to sleep than among those sleeping on their backs. They should also not be placed on their sides to sleep. A baby can easily roll from a side position onto the belly during sleep. Infants who die from SIDS may have a problem with the part of the brain that helps control breathing and waking during sleep. If a baby is breathing stale air and not getting enough oxygen, the brain usually triggers the baby to wake up and cry to get more oxygen. If the brain is not picking up this signal, oxygen levels will continue to fall.”

There are certain factors that may increase a baby’s risk of SIDS. These include age, sex, race, family history, secondhand smoke, and being born prematurely.

Adding further, Dr Aggarwal, said, “When compared with infants who sleep on their backs, infants who sleep on their stomachs are less reactive to noise; experience sudden decreases in blood pressure and heart rate control; and experience less movement, higher arousal thresholds, and longer periods of deep sleep. The simple act of placing infants on their backs to sleep significantly lowers SIDS risk.”

Here are some tips that may reduce the chances of SIDS in babies.

• Get early and regular prenatal care.
• Place the baby on a firm mattress to sleep on not on other surfaces.
• Cover the mattress with a fitted sheet. Keep soft objects and loose bedding out of the sleep area.
• Avoid bumper pads as they can lead to suffocation or strangulation.
• Practice room-sharing without bed-sharing. Experts recommend that infants sleep in their parents' room but on a separate surface at least for 6 months, when the risk of SIDS is highest.
• Breastfeed exclusively as far as possible, for the first six months.
• Make sure the baby does not get too warm while sleeping. Dress them as per the room temperature, and don't over bundle.
• Don't smoke during pregnancy or after birth. Smoking, both active and secondhand, is a risk factor for SIDS.
• Do not use alcohol or drugs during pregnancy or after birth. Parents who drink or use drugs should not share a bed with their infant.
• Ensure that the baby gets all recommended immunizations.

High-sugar diet increases risk of heart disease in healthy people

High-sugar diet increases risk of heart disease in healthy people

Dr KK Aggarwal

A study from the UK has shown that healthy people who eat high amounts of sugar are at an increased risk of developing heart disease due to alteration in their fat metabolism.

The study reported October 4, 2017 in the journal Clinical Science examined two groups of men with either high or low levels of liver fat, and fed them a high (650 calories daily) or low sugar (≤140 calories daily) diet to find out if the amount of liver fat influences the impact of sugar on their cardiovascular health.

Men who had high levels of liver fat (non-alcoholic fatty liver disease [NAFLD]) had changes in their fat metabolism that are associated with an increased risk of cardiovascular disease, heart attacks and strokes after 12 weeks on the high sugar diet.

What is important to note in this study is that when the group of healthy men with a low level of liver fat consumed high amounts of sugar, their liver fat increased and their fat metabolism became similar to that of men with NAFLD putting them at risk of heart disease.

With the festive season coming up, we all should take care to not eat too many sweets. Diwali sweets have very high content of white sugar and cause metabolic syndrome, insulin resistance and consequent increase in blood pressure, blood sugar and body weight. Some sweets may be made in trans fats (vanaspati), which lower the good cholesterol and increase bad cholesterol.

The findings of the study are especially relevant for the young who regularly consume foods and drinks high in added sugars. Lifestyle disorders like diabetes, obesity, hypertension, heart disease, stroke, NAFLD are escalating in our country mainly due to an unhealthy lifestyle. What is of more concern is that these diseases are now affecting people at a younger age.

(Source: University of Surrey Press Release, October 4, 2017)

Vitamin D supplements can help cut the risk of asthma attacks

Vitamin D supplements can help cut the risk of asthma attacks

· Over 20 million people in India suffer from asthma

· Airway sensitivity both rural and urban areas has gone up due to many factors

New Delhi, 09 October 2017: As per a recent study, taking oral vitamin D supplements in addition to standard asthma medication causes a 30% reduction in asthma attacks requiring treatment with steroid tablets or injections, in those with mild-to-moderate asthma. As per the findings, there was a 50% reduction in the risk of people experiencing at least one asthma attack requiring hospitalization or visit to emergency Dept with vitamin D supplementation. Vitamin D is thought to protect against attacks triggered by viral upper respiratory infections by boosting immune responses and dampening down harmful airway inflammation.

A chronic lung disease that inflames and narrows the airways, asthma causes recurring episodes of wheezing, chest tightness, shortness of breath and coughing. The coughing often occurs at night or early in the morning. About 15 to 20 million people in India have asthma, and some studies even put this number at 30 million.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “It is important to understand the working of airways to understand asthma. The airways are tubes that carry air into and out of the lungs. In people with asthma, these airways are inflamed, which makes them swollen and very sensitive. Due to this, the airways react strongly to certain inhaled substances, which causes the muscles around them to tighten. As a result, the airways become narrow causing less air to flow into the lungs. The cells in the airways might make more mucus than usual. All these can result in asthma symptoms, which can occur each time the airways are inflamed. Asthma attacks are also known as flare ups or exacerbations.”

Adding further, Dr Aggarwal, said, “Airway sensitivity is going up among people in both rural and urban areas due to sustained exposure to a combination of triggers. Asthma requires continuous medical care and those with moderate-to-severe asthma must take long-term medicines such as anti-inflammatory drugs. These should be taken every day to prevent symptoms and attacks. Short-term medicines such as inhaled short-acting beta2-agonists are also used for quick relief of asthma symptoms.”

Here are some tips to prevent asthma.

Follow your care plan diligently. Asthma needs regular monitoring and following your prescribed medication schedule can help you manage symptoms to a great extent.
Identify what triggers an attack. It could be anything from outdoor allergens and irritants to household dust and mites.
Monitoring your breathing and identifying a possible attack can also help you in taking medications and precautions in a timely manner, thus avoiding flare ups.
Getting vaccination for influenza and pneumonia can prevent asthma flare ups.

Ovarian cancer symptoms not apparent until later stages

Ovarian cancer symptoms not apparent until later stages • It is the eighth most common cancer in women • Lifestyle changes can help reduce risk New Delhi, 18 September, 2017: Of all cancers in women, ovarian cancer is the eighth most common cancer and ranks fifth in terms of mortality, according to statistics. About two-thirds of those with this condition stand at an advanced stage of the disease during diagnosis and less than 50% survive longer than five years after being diagnosed. As per the IMA, the primary reason for reaching the advanced stage and eventual death is that in many women with this disease, there are no symptoms. Ovarian cancer refers to any cancerous growth in the ovary. A majority of ovarian cancers arise from the epithelium (outer lining) of the ovary. The most common ovarian cancers are called epithelial ovarian cancers (EOC) and other types include ovarian low malignant potential tumor (OLMPT), germ cell tumors, and sex cord-stromal tumors. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "Ovarian cancer often goes undetected until it spreads within the pelvis and stomach. In such an advanced stage, it may not be possible to treat the condition making it life threatening. Often, this condition has no symptoms in the early stages and even at a later stage; there are non-specific symptoms such as loss of appetite and weight loss. Mutations in BRCA1 and BRCA2 are responsible for most inherited ovarian cancers. When these genes are normal, they help prevent cancer by making proteins that keep cells from growing abnormally. However, inheriting a mutation in one of these genes from either parent, makes this cancer preventing protein less effective. This increases the chances of developing ovarian cancer.” Some possible early symptoms of ovarian cancer include pain in the pelvis, lower side of the body, lower stomach, and back; indigestion or heartburn; feeling full rapidly when eating; more frequent urination; pain during intercourse; and changes in bowel habits. As it progresses, symptoms such as nausea, weight loss, breathlessness, tiredness, and loss of appetite can also appear. Adding further, Dr Aggarwal, said, “The treatment for this condition consists of surgery, chemotherapy, a combination of surgery with chemotherapy, and at times, radiotherapy as well. The mode is decided depending on factors such as type of ovarian cancer, its stage and grade, and the patient’s general health. Contraceptive pills can help reduce the risk of ovarian cancer in women and also protect them from the disease even 30 years after they stop taking the drugs.” Some other tips that can help prevent the risk of ovarian cancer in women include the following. Breastfeeding The longer a woman breastfeeds, the lower her risk of ovarian and fallopian tube cancer. Pregnancy The more full-term pregnancies a woman has had, the lower her risk of ovarian and fallopian tube cancer. Surgical procedures Women who have had a hysterectomy or a tubal ligation may have a lower risk of developing ovarian cancer. Adopting a healthier lifestyle This entails consuming more fruits and vegetables, exercising regularly, and avoiding smoking and drinking.

BP mismatch between arms signals risk

BP mismatch between arms signals risk Patients with hypertension who have more than 10 mmHg digit differences in blood pressure between arms may be at risk for cardiovascular events and premature death New Delhi, April 10, 2017: A recent study at Harvard-affiliated Massachusetts General Hospital measured blood pressure—in both arms—of 3,400 participants age 40 or older with no signs of CVD. The results showed average arm-to-arm difference of approximately 5 points in systolic blood pressure (the first number in a BP reading). About 10% of the subjects had differences of 10 or more points in the same. The subjects were followed for the next 13 years; people with arm-to-arm mismatch of 10 points or more were 38% more likely to have had a heart attack, stroke, or a related cardiovascular problem. Padma Shri Awardee Dr. K.K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement said that, “Minor difeferences in blood pressure measurements between the two arms is fairly common and normal. However, large mismatches are indicative of artery-clogging plaque in the vessel that supplies blood to the arm that is showing higher blood pressure. Presence of such a plaque is a sign of peripheral artery disease, which is basically the presence of cholesterol-clogged arteries in the body other than the heart. Presence of peripheral artery disease increases the likelihood of a similar plague being formed in the heart and brain, increasing the chances of a heart attack or a stroke.” “Peripheral artery disease is estimated to affect about 10 million people in India with a prevalence rate of 3.2%. While most cardiologists in routine medical practice measure blood pressure in both arms as part of evaluation, most primary care physicians don’t. Bilateral blood pressure measurements should become a routine part of cardiovascular assessment in primary care”, added Dr. Aggarwal. Following tips should be kept in mind while monitoring your blood pressure at home: • Avoid fluids like caffeine, alcohol, and nicotine during the 30 minutes prior to taking your reading. • Relax and sit down straight for a few minutes with your feet straight and lowered. • While measuring, rest your arm on your elbow so that the arm is at level with the heart. • Wrap the cuff over the skin of your upper arm. Measure your blood pressure according to the machine’s instructions. • Leave the deflated cuff in place, wait a minute, then take a second reading. If the readings are close, average them. If not, take a third reading and average the three. • Repeat the procedure in the other arm. • If a mismatch of 10 points or more is found in the arms in consecutive measurements, consult a physician.

Have a healthy breakfast to reduce the risk of diabetes

Have a healthy breakfast to reduce the risk of diabetes

Eating a healthy breakfast decreases the risk of developing type 2 diabetes


New Delhi, March 19, 2017:  American Diabetes Association repeatedly emphasizes on the importance of starting the day with a healthy breakfast to help prevent the onset of type 2 diabetes and effectively manage all types of diabetes to avoid complications.


Diabetes is a huge and growing burden: while 382 million people were living with diabetes in 2016 that number is expected to balloon to almost 600 million people by 2035. Diabetes is fast gaining the status of a potential epidemic in India with more than 62 million diabetic individuals currently diagnosed with the disease.

Up to 11% of total healthcare expenditure in every country across the globe could be saved by tackling the preventable risk factors for type 2 diabetes and over 70% of type 2 diabetes cases can be prevented or delayed by adopting healthier lifestyles.


*Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA* in a joint statement said,
“On average, breakfast skippers snack more often, eat more sugary, high-fat snacks, drink more soda, are more likely to overeat at night, and are more often overweight or obese than breakfast eaters. Either way, breakfast is
especially important for people with diabetes. For someone on insulin, if there's no food on board, that person runs the risk of hypoglycemia or lowblood sugar.”

 “A healthy diet containing leafy vegetables, fresh fruit, whole grains,lean meat, fish and nuts can help reduce a person’s risk of type 2 diabetes and avoid complications in people with diabetes. A healthy diet is, more
expensive than an unhealthy one. The wide availability of cheap energydense low-nutrient food is contributing to the global epidemic of type 2 diabetes. Foods which reduce the risk of type 2 diabetes such as
vegetables, fresh fruit, whole grains and unsaturated fats need to be moreaffordable and more widely available”, adds *Dr K K Aggarwal.*

The best breakfasts are low in carbohydrates and fat, and high in protein and fiber. Ideally, you should get between 7 and 10 grams of fiber at breakfast, which will fill you up. Breakfast that has protein added in it
is what creates that satiety and prevents snacking later on.

Following are some healthy breakfast options for those with diabetes or those looking to prevent it:

   - Missi Roti: Rich in dietary fiber and a chromium reserve which helps    in diabetes control.
   - Barley Soup: It is rich in fiber and has more essential nutrient than    refined grains.
   - Vegetable omelet: High satiety index and low on glycemic index
   - Ragi Uttapam: Rich in calcium and essential nutrients.
   - Brown Bread and Brown Rice: Have low glycemic index than white rice,    also a good source of dietary fiber
   - Go for natural sweeteners like jiggery, anjeer or salvia. The sugar in    these products is fiber bound and hence healthy.

Short sleep duration as a risk factor for childhood obesity

Short sleep duration as a risk factor for childhood obesity Childhood obesity is a global public health problem that has increased at an alarming rate, more so in the low- and middle-income countries. According to the WHO, in 2015 the number of overweight children under the age of five globally was estimated to be over 42 million. Almost half of all overweight children under 5 lived in Asia and one quarter lived in Africa. The causes of obesity are variable, genetic, lack of physical activity, unhealthy eating patterns, or a combination of these factors. Addressing obesity assumes importance given that overweight and obese children are likely to be obese adults and more likely to develop noncommunicable diseases (NCDs) like diabetes and cardiovascular diseases at a younger age. Several studies have described short sleep duration as a risk factor for obesity, including childhood obesity. Excess carbohydrate consumption has been suggested as a possible mechanism due to increased hunger through dysregulated hormonal mechanisms that involve decreased leptin (satiety hormone – suppresses appetite) and increased ghrelin (hunger hormone) levels. Lack of sleep disturbs the balance between these hormones. This association between short sleep duration and risk of obesity in children was demonstrated in a study published in the February 2017 issue of the journal Sleep. Researchers examined the association between estimated sleep duration and macronutrient intake as percentages of total energy among Mexican American (MA) 9–11 year old children. The intake of carbohydrates decreased with longer sleep duration. Children who slept for longer duration ate fewer calories from carbohydrates and a higher percentage from fat, especially from PUFAs. This study highlights the role of sleep in the prevention of obesity emphasizes the need to inculcate good sleep hygiene in children. Here are a few tips to do so: • Set a regular and consistent sleep schedule. • Remove TV and computers from the child’s bedroom. • Avoid caffeinated products close to bedtime. • Plan up to 1 hour of quiet time before bed such as reading a book. • Make sure that the child does not go to bed hungry. Dr KK Aggarwal National President IMA & HCFI

Eating fruits and vegetables may lower risk of dementia in older adults

Eating fruits and vegetables may lower risk of dementia in older adults A population-based observational study published February 10, 2017 in the journal Age and Ageing has yet again provided evidence for the benefits of eating fruits and vegetables. The study says that at eating least three servings of vegetables and two servings of fruits daily might help prevent dementia in older adults. Researchers examined the diet of more than 17,000 Chinese older adults who attended the Elderly Health Centres in Hong Kong who did not have at study baseline. Their cognitive status was followed up for 6 years. The cut-off for minimal intake of vegetables and fruits was defined as that recommended by the WHO as at least three and two servings per day, respectively Compared with adults who did not adhere to WHO recommendations for fruit and vegetable intake, adults who consumed three servings of vegetables and two servings of fruits daily were found to be at lower risk of dementia development over 6 years. Dementia risk was further reduced for adults who consumed an additional three portions of vegetables each day, the team reports. According to the authors, the study also highlights the importance of daily intake of fruits and vegetables for cognitive maintenance. (Source: Medical News Today) Dr KK Aggarwal National President IMA & HCFI

Physical activity may lower risk of 5 diseases

Physical activity may lower risk of 5 diseases People who achieve total physical activity levels several times higher than the current recommended minimum level significantly lower their risk of five diseases namely breast and bowel cancer, diabetes, heart disease and stroke, says a systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013 published August 9, 2016 in the BMJ. This is the first meta-analysis, which has quantified dose-response association between total physical activity across all domains and the risk of five chronic diseases and analyzed data from 174 cohort studies. Compared with individuals with total activity <600 MET minutes per week, the risk reduction for those in the highly active category (≥8000 MET minutes per week) was 14% for breast cancer, 21% for colon cancer, 28% for diabetes, 25% for ischemic heart disease and 26% for ischemic stroke. These results suggest that total physical activity needs to be several times higher than the recommended minimum level of 600 MET minutes/week for larger reductions in the risk of these diseases. The WHO recommends at least 600 metabolic equivalent (MET) minutes of total activity (irrespective of domains) per week for health benefits i.e., about 150 minutes/week of brisk walking or 75 minutes per week of running. This high level of total activity can be achieved by combining different types of physical activity into the daily routine. Focusing on a particular domain such as leisure time physical activity, which represents only a small fraction of total activity, as was done by most studies, restricts the scope of applicability of the findings.