EXERCISES FOR NON

COMMUNICABLE
DISEASES
PARUL CHAUHAN
PHYSIOTHERAPIST
AIIMS
• Non-Communicable Diseases (NCDs) are also termed 
chronic diseases. NCDs are collectively responsible for 71% of all
deaths worldwide. Almost three quarters of all NCD deaths, and 82%
of the 16 million people who died prematurely, or before reaching 70
years of age, occur in low- and middle-income countries.
•   NCDs also account for 48% of the healthy life years lost (Disability
Adjusted Life Years–DALYs) worldwide (versus 40% for
communicable diseases, maternal and perinatal conditions and
nutritional deficiencies, and 1% for injuries).
• Non-communicable diseases are a diverse group of chronic diseases that
are not communicable, meaning you can't catch them from another person.
• They are defined as diseases of long duration, generally slow progression
and they are the major cause of adult mortality and morbidity worldwide.  
• Non-communicable diseases are identified by WHO as “Group II
Diseases,” a category that aggregates (based on ICD-10 code) the
following conditions/causes of death: Malignant neoplasms, other
neoplasms, diabetes mellitus, endocrine disorders, neuropsychiatric
conditions, sense organ diseases, cardiovascular diseases, respiratory
diseases (e.g. COPD, asthma, other), digestive diseases, genitourinary
diseases, skin diseases, musculoskeletal diseases
• These disease groups are linked by common risk factors:
1.Social Determinants of Health (this is the environment in which we
are born, live and grow and the opportunities we are given in those
environments)
2.Tobacco
3.Alcohol
4.Poor Nutrition
5.Physical Inactivity
• Metabolic risk factors contribute to four key metabolic changes that
increase the risk of NCDs:
• raised blood pressure;
• overweight/obesity;
• hyperglycemia (high blood glucose levels); and
• hyperlipidemia (high levels of fat in the blood).
• In terms of attributable deaths, the leading metabolic risk factor
globally is elevated blood pressure (to which 19% of global deaths
are attributed) , followed by raised blood glucose and overweight
and obesity.
• Q: What is physical activity?
• Physical activity is defined as any bodily movement produced
by skeletal muscles that requires energy expenditure. Physical
activity includes exercise, as well as other activities which
involve bodily movement and are done as part of playing,
working, active transportation, household chores and
recreational activities
•  What is the intensity of physical activity?
• 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.
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.
• Moderate intensity requires a moderate amount of effort and noticeably
accelerates the heart rate, such as brisk walking, dancing, gardening
and housework. While vigorous intensity requires a large amount of
effort and causes rapid breathing and substantial increase in heart rate,
such as fast cycling, running, aerobics and climbing up a hill
ROLE OF PHYSIOTHERAPISTS
• Physiotherapists specialise in human movement, physical activity,
promoting health, fitness, and wellness.
• They identify physical impairments, limitations, and disabilities that
prevent people from being as active and independent as they might be,
and then they find ways of overcoming them.
• The profession of physiotherapy helps millions of people every year
to prevent non-communicable diseases and their risk factors – most
importantly obesity. Through targeted rehabilitation methods they also
manage the effects of NCDs to optimise health when they are present.
• People with chronic health problems can improve their health by
learning how to increase physical activity levels and exercise safely
under the guidance and instruction of physiotherapists.
• The scoping review suggests exercise-based rehabilitation programs
can be implemented in low resource settings.
• Activity has to be introduced carefully if a person is overweight, unfit,
older, or has a chronic disease.
• Physiotherapists do this by examining the person, recommending
exercises that are safe and appropriate for them, and educating them
about how to look for signs of trouble.
• This makes them the ideal professionals to prescribe physical activity
and exercise programmes for non-communicable diseases.
INTERNATIONAL RECOMMENDATIONS
• WCPT encourages and supports its member organisations to:
• advocate for exercise and physical activity as the low cost and universally
available means of reducing the risk factors for NCDs;
• advocate that physical therapists are well placed to advise on appropriate
and effective physical activity programmes for individuals and targeted
populations, such as the elderly, people with long-term conditions or those
with disability (including intellectual disability);
• advocate that sufficient resources should be allocated to confronting those
NCDs that can be prevented and treated by physical therapists;
• advocate for equality of opportunities and rights when it comes to the
allocation of resources to physical therapy to prevent and treat NCDs;
• advocate for national policies, programmes, services and systems
that enable physical therapy services to be delivered effectively to
people with NCDs and/or their risk factors;
• advocate for physical therapist involvement in the development and
delivery of evidence based, affordable, cost effective, population-wide
physical activity programmes across health and related service
systems (eg social, education, and community services);
• advocate for the involvement of physical therapists in research which
contributes to understanding effective interventions, including
prevention, for NCDs and their risk factors;
• publishing information in professional publications; - raising
awareness of the important role of physical therapists in the
prevention of disability and mortality associated with NCDs and their
risk factors;
• promoting and using a health promotion approach to empower
people and involve them in decisions about health behaviours to
reduce their NCD risk; - exchanging information within the physical
therapy community (eg through websites and forums) on the
prevention and management of NCDs and their risk factors, including
a focus on reducing inactivity and sedentary behaviours.
• promote the involvement of physical therapists in the development
and implementation of national NCD plans;
• advocate for public policies and practices that empower individuals,
families, and communities to make healthy choices and lead healthy
lives;
• support global initiatives on NCDs and emphasise the evidence for
the efficacy of physical activity in the prevention of NCDs and their risk
factors; :
• support interprofessional collaborative practice and person-centred
integrated service delivery that are necessary for successful prevention
and management of NCDs and their risk factors;
• promote the use of the best evidence in preventing and managing NCDs
and their risk factors by: - utilising existing databases and evidence-based
literature on clinical and cost effective interventions; - publicising funding
sources for research on the efficacy of physical therapy in the prevention
and management of NCDs and their risk factors;
• educate health professional communities, service users, and the public
about the crucial roles of physical therapists and the benefits of their
interventions in combating the NCD epidemic through
ACCORDING TO W.H.O.
• In adults, physical activity confers benefits for the following health
outcomes:
• improved all-cause mortality, cardiovascular disease mortality,
incident hypertension, incident site-specific cancers,2 incident type-2
diabetes, mental health (reduced symptoms of anxiety and
depression); cognitive health, and sleep; measures of adiposity
may also improve.
• Adults should also do muscle strengthening activities at moderate or
greater intensity that involve all major muscle groups on 2 or more
days a week, as these provide additional health benefits.
• Strong recommendation, moderate certainty evidence 150- 300
minutes moderate-intensity aerobic physical activity vigorous-
intensity aerobic physical activity or an equivalent combination
throughout the week minutes or At least at least 75 muscle-
strengthening activities at moderate or greater intensity that involve
all major muscle groups.
• For additional health benefits: 2 days a week On at least 4 Guidelines
on physical activity and sedentary behaviour: at a glance 1 Site-
specific cancers of: bladder, breast, colon, endometrial, oesophageal
adenocarcinoma, gastric, and renal.
 Moderate aerobic exercise acutely improves BG and insulin action
Mild-intensity post-meal walking for 15 min is efective for glucose
homeostasis and easy to perform in the activities of the daily life of
type 2 diabetes patients combination of aerobic and resistance exercise
training may be more effective in improving BG control than either
alone . PA can result in acute improvements in systemic insulin action,
lasting from 2 to 72 h
• The implementation of exercise brings about a decrease in plasma
triglyceride level, an increase in HDL cholesterol, and improvement of
mild hypertension. Thus, physical exercise exerts an inhibitory efect
on the development and progression of atherosclerosis through a
number of mechanisms
• Most adults with type 1 and type 2 diabetes should engage in 150 min
or more of moderate-to-vigorous intensity aerobic activity per week,
spread over at least 3 days/week, with no more than two consecutive
days without activity. Shorter durations (minimum 75 min/week) of
vigorous-intensity or interval training may be sufficient for younger
and more physically ft individuals. Adults with type 1 and type 2
diabetes should engage in 2–3 sessions/week of resistance exercise
on nonconsecutive days. Especially for elderly diabetes patients who
tend to have muscle atrophy (sarcopenia), mild-intensity resistance
training, such as half squats and calf raise should be performed in
addition to aerobic exercise
Brisk walking
Jogging
Resistance Training
Treadmill
Cycling
Half squat
Calf raise
PRECAUTIONS
• People using medications, such as beta-blockers, should be cautious of
developing heat illness when exercising. These medications and diuretics
impair the ability to regulate body temperature.
• Adults with hypertension should extend the cool-down period of the
workout. Antihypertensives, such as alpha blockers, calcium channel
blockers, and vasodilators, may cause BP to lower too much after abruptly
ending exercise.
• Overweight and obese adults with hypertension should combine regular
exercise and weight loss to effectively lower resting BP.
• Promoting the BP-lowering effects of single exercise sessions may best
motivate people to exercise. Physicians are encouraged to promote the role
of exercise in controlling BP to their patients.
Table 1. Summary of the Physical Activity Recommendations for Americans*
Aerobic exercise Muscle-strengthening (resistance) exercise
For substantial health benefits* Should be performed:
  150–300 min/wk of moderate-intensity  ≥2 times/wk
physical activity,† or
  75–150 min/wk of vigorous-intensity physical
 Involving all major muscle groups
activity,‡ or
 An equivalent combination of moderate- and  At moderate intensity or greater
vigorous-intensity physical activity
• Exercise should be avoided if fasting glucose is >250 mg/dL and
blood or urine ketones are elevated; carbohydrates should be ingested
if glucose is <100 mg/dL, and blood glucose monitoring should be
carried out before, during and after physical activity; and the
consumption of food during extensive exercise is suggested in order to
avoid hypoglycaemia.8