The Art and Science of Fitness | Reviving ancient exercise principles for today's wellness warriors

Revisit the wisdom of Sushruta to redefine our approach to fitness, prioritising personalised exercise regimens, mindful movement, and holistic well-being

We all need to be fit to sit, stand, walk and do any movement optimally in our lives, but fitness is often considered to be only for a select few who want to compete at the elite level. Before diving into the question of whether you are working out too much or too less in the gym, we first need to figure out how humans throughout the ages have been advised to exercise to stay healthy and counter the effects of diseases.

Even though we have known and have been prescribed exercises for thousands of years, it's seemingly only a handful who end up picking a physically active lifestyle, playing sports and doing exercises(Pixabay)

As much as exercising seems like a recent western phenomenon, based on our epics like Ramayana and Mahabharat, it is clear that being physically fit was considered as important in gurukuls as excelling in academics. Even western medical publications such as Advances in Physiology Education credit our own Sushruta with being the first physician to have prescribed daily exercises. This was about 2,700-3,000 years ago.

A few centuries later, Hippocrates, popularly known as the ‘father of medicine’, was recorded as the first physician to have given written exercise prescriptions to his patients. In about 200 AD, it was Galen, chief physician to gladiators and Rome’s military campaigns, who influenced recommendations of exercising to maintain health and prevent sickness. This carried on till the 19th century. And that’s when allopathic medicine made its appearance, where passive treatment took over from an active approach.

Exercise as prescribed by Sushruta

‘Sushruta Samhita’, the ancient Sanskrit text on medicine and surgery, mentions that exercise should be taken every day and in moderation, as otherwise it may prove fatal. Even three millennia ago, exercises were prescribed based on age, strength, physique, exercise terrain and diet of the individual. But today, people ape others and are in a rat race to do more than the one next to them, and soon get into trouble.

Sushruta thought that exercise was important to make the body strong, firm, compact, and light, enhance the growth of limbs and muscles, improve digestion and complexion, prevent laziness, reduce senility and preserve health. Today, all of this is backed up by the most recent scientific studies published in the top medical journals.

Why pick up exercising?

Even though we have known and have been prescribed exercises for thousands of years, it's seemingly only a handful who end up picking a physically active lifestyle, playing sports and doing exercises. But the ones who do, why do they do it? This question is important to be answered before figuring out the amount of workouts in the gym.

One set of individuals goes to the gym for the same reason Sushruta was recommending exercise all those years ago, which is, broadly speaking, for improved physical function, better metabolic health and healthy ageing, besides rehabilitation from pre-existing medical conditions. Then some are passionate about exercise. It could have started because of health reasons, or because they love being fit and achieving a ‘high’ during their exercises. Finally, some have got addicted to working out, and their identity is connected to exercising and being at the gym.

Longevity: Lifespan+healthspan

In his best-selling book, ‘Outlive: The Science and Art of Longevity, Peter Attia talks about VO2 max and grip strength being the two most important indicators for longevity. VO2 max refers to the maximum amount of oxygen that an individual can utilise during intense or maximal exercise and grip strength, as the term suggests, is how firm is your grip hold. Now, I don’t get excited about living longer as quality of life excites me a lot more, no matter how short the life is. I have already outlived Alexander the Great, who spent 32 years on this planet earth. Whatever of my life is left here, I want it to be of the best possible quality. It then helps that Attia defines longevity as a function of both lifespan, i.e. the number of years you live, and health span, how well you can live them.

Attia suggests that we need to do cardiovascular exercises in zone 2 to improve VO2 max, which is backed by scientific research as well. There are a lot of complicated ways to find out if you are working out in that zone, but the most practical one involves exercising at an intensity where you can keep talking, just that it is not comfortable and you would rather shut up if given a choice. I like the simplicity of this and have been advocating the same to folks for about a quarter of a century. Besides everything else, it helps people become more independent and listen to their minds and bodies, rather than become slaves to gadgets and numbers.

When it comes to grip strength, strength training helps it and more to become better. It further leads to better physical functioning and better quality of life. Muscles are crucial to get us from one place to another, to improve our metabolic health and help us age well. Even Sushruta recommended a similar approach to strengthening, cardiovascular and overall fitness, about 5,000 years ago.

Strength training: Safely and optimally

There are different ways to go about with strength training, some more effective than others, but anyone who strength trains, is better off than those who don’t. To get the best result for the time spent, I prefer one single set of 8-10 strength training exercises during a session, covering the whole body, for two to three times a week.

The important thing to remember is to keep the movement slow while exercising and not to do explosive movements as that’s where injuries happen. For example, while doing biceps curl, flex your arm slowly and smoothly over 4 seconds, hold for 2 seconds and then extend back over 4 seconds, effectively taking 10 seconds per repetition. The weight should be such that you can do the exercise for 6 to 9 repetitions, i.e. 60 to 90 seconds. If you can do more than that, it means the weight is too light for you and the exercise was too easy. If so, stop after 10 repetitions, i.e. 100 seconds.

During the next session, increase the weight by a slight bit. But if you weren’t able to do even 6 repetitions, i.e. less than 60 seconds, stop for the day with that exercise as the weight was too heavy for you. For the next session, reduce the weight by a bit while again targeting 6 to 9 repetitions, 60 to 90 seconds. This approach makes strength training customised to your needs and what you are capable of doing.

Less is more

There needs to be a gap of 48 to 72 hours between strength training sessions because muscles need time to rest, recover, adapt and get stronger. This holds true when strength training sessions happen at high intensity, where you are exerting yourself. If strength training sessions happen sooner, like every day, the chances of injuries increase many fold and strength doesn’t increase as much as it optimally could have. That means you should only do 2-3 sessions of high-intensity strength training every week.

This protocol was brought to the mainstream by Arthur Jones (founder of Nautilus and MedX) in the 1970s and then popularised by Mike Mentzer (bodybuilder) in the 1980s, followed by Dorian Yates, the six times Mr Olympia (1992-1997). Arnold Schwarzenegger, who won Mr Olympia seven times, used to do strength training for 2-4 hours a day, at times, two times a day, every day of the week. He would exercise different body parts on different days.

Nothing wrong with Schwarzenegger's approach since it obviously worked, just the problem we have here is that people are overtraining, lifting very heavy weights, not focusing on form, and exercising every day, without enough recovery or rest. Muscles need time to recover to be able to adapt optimally. These sessions would get over in 30-40 minutes, a time easy to spare for anyone. One could argue that if you don’t take out time for yourself right now, soon enough you’ll have a lot of time when your poor lifestyle will wreck your life. But then again, I am done preaching. I now only try to figure out ways that can get everyone moving so they can live a happy and healthy life.

In this fast-paced life, I recommend people to do a whole body workout on the same day, 2-3 times a week, rather than different body parts while training 5-6 days a week. That helps to get the results in the limited time we folks have, keeping the journey as safe as possible.

Exercise form

More than the weight you are lifting, focus on good form for every single repetition. As soon as the form doesn’t seem to be correct, stop. Most injuries in the gym happen while doing the last or the second last repetition of any exercise when their form is really poor. So, always focus on the form.

To work on form, it is best to start from the beginning. Just before starting any exercise, whether machine-based, free weights or body weight, think about what body part that exercise is working on. Now close your eyes and visualise that exercise and feel that particular body part it is supposed to work on, straining. That drill will give you an idea of what the exercise should feel like and where. When you start the exercise, if the strain at any time is on any other body part, you are effectively doing it incorrectly. It could be because the weight was too heavy to begin with and it now feels too heavy after a few repetitions, or your form is just wrong. Also, if there is a strain on any other body part, you need to stop. An example would be feeling a strain in your neck or lower back while doing bicep curls. There is something wrong, so immediately stop.

Another thing to focus on at the beginning of the exercise is to not have a stiff rigid posture. The common mistakes that are made are that people have their shoulders shrugged and/or slouched. If the starting position is poor, and then you start exercising, you are reinforcing that and making that posture permanent. When you start any exercise, think of having a tall posture, as if you are being pulled up like a puppet. While you do that, let your shoulders loose, let them fall, not shrug.

Breathing

This is another mistake that most gym goers make, they hold their breath. Keep taking easy breaths in and out, independent of movement while doing the exercise. When people hold their breath, especially while lifting a heavy weight, they excessively increase their intra-abdominal pressure and expose themselves to inguinal hernias or disc bulges in the neck or lower back. It is preferable to breathe in through the nose and breathe out through the mouth, but if it makes you comfortable breathing in and out through the mouth, that’s fine too. Just don't hold your breath.

Move at your pace

When doing group classes in the gym, the problem is that because of peer pressure, people try to keep up with the best, rather than do what their fitness level allows, hurting themselves again. I usually tell people to back off and first get ready to be able to take part in group classes.

Then there is cardiovascular exercise. Similar to advice for strength training, it is best to have 2-3 days per week of targeted training where you look at long runs, intervals and/or tempo workouts. It is ok if you run on 2-3 other days of the week too, but keep them as easy runs, so they count as active rest days. You could add another 2-3 days a week of easy walks or runs of 20-30 minutes, which I like to call active rest. On these days you don't exert yourself.

Overall, no one size fits all. You need to figure out what it is that you are after and what is your current fitness level. In any case, recovery and nutrition are very important to optimise results from your training. Never compromise on your sleep. Last of all, if your mental health isn’t in top shape and you are exerting excessively while exercising, you are only making things worse. Yes, exercise helps mental health, but not when you are doing high-intensity workouts, without enough rest and good nutrition, then it is a recipe for disaster.

Keep miling and smiling.

Dr Rajat Chauhan (drrajatchauhan.com) is the author of The Pain Handbook: A non-surgical way to managing back, neck and knee pain; MoveMint Medicine: Your Journey to Peak Health and La Ultra: cOuch to 5, 11 & 22 kms in 100 days

He writes a weekly column, exclusively for HT Premium readers, that breaks down the science of movement and exercise.

The views expressed are personal