Ayurvedic physician recommend exercises on daily basis for good health and longevity. The Ayurvedic approach to exercise focuses not only on the physical benefits, but also on its positive influence on mind and heart when customized to suit individual needs for balance. Walking (Parikramana) is very well described by our Ayurvedic physician in reference to Prameha.[1] Exercise (Vyayama) is defined as the Karma that produces Ayasa (tiredness) in the body is known as Vyayama.[2] Caraka has described that the effort which produces stability and strength in the body is known as Vyayama.[3] Prakriti, the build and constitution of the human body is a sum total of morphological, physiological and psychological traits of human beings. Prakriti of a man has genetic and acquired aspect, the genetic aspect depends upon Shukra and Shonita,[4] while acquired constitution develops in relation to environmental factors like climate, season, time factor, age, race and individuals (Pratyatmniyta).[5] Walking is very important and most convenient exercise. It can be prescribed for all age group patients mainly in diabetics. In advanced stage of Prameha, the patient should put into practice of physical exercise, wrestling, sports, riding elephant, horse and chariot, travelling on foot and moving around and also feats of archery therefore, walking is mainly indicated in Madhumeha (diabetes mellitus).[1] It is also mentioned that those who are not doing exercise (physical activity) and taking high calorie diet are mostly prone for Prameha.[6] As per Bhela Samhita, life style without exercise is also a cause of Prameha.[7] Diabetes mellitus is defined by American Diabetes Association (ADA) expert committee in their recommendation as group of metabolic disorders characterized by hyperglycemia resulting from defect in insulin secretions, insulin action or both.

In the present study, effect of exercise has been observed in diabetic patients. Thirty minutes walking (Isotonic aerobic exercise) was prescribed to diabetic patients for 3 months (Two follow-ups) on empty stomach. During the study period low calorie diet was prescribed. The diabetic patients had performed walking in their own home under the physicians guidance. Initial step of exercise was 5 minutes of warm up followed by 5 minutes of cool down. Along with walking some important breathing exercises have also prescribed like Kapalabhati, Anuloma–Viloma and deep slow breathing during both expiratory and inspiratory phases for 15 minutes. Two follow-ups have been completed during study, 1 month and after 3 months. During the study period, the enrolled patients were allowed to consume their routine anti-diabetic medicines.

Study has been divided in to two groups and comprised of total 83 patients in between 35-65 years of age. Maximum number of patients (53.01%) were males [Table 1]. First of all, evaluation of Prakriti was done by the proforma prepared for the assessment of Prakriti based on distinctiveness described in various standard texts book of Ayurveda. Deha Prakriti was designated in terms of three Dwandaja Prakriti. Ekadosaja Prakriti and Tridosaja were not considered in our study because Ekadosaja Prakriti is rare while Tridosja Prakriti individuals are free from diseases.

Several long term studies have demonstrated consistent beneficial effect of exercise on prevention of diabetes. Present study comprised of 83 diabetic individuals belonging to the age group of 35 – 65 years with the aim to find out any correlations that may exist between these physiological parameters and Prakriti. There is a strong correlation between changing lifestyle factors and increase in diabetes in India. Maximum number of patients (53.01%) were males. This study was not consistent with other because the maximum numbers of studies have shown high prevalence of female diabetics world wide.[9] Maximum number of cases belonged to Vata–Piitaja (VP) Prakriti and minimum number of cases belonged to Vata-Kaphaja (VK) Prakriti. VP Prakriti individuals were very reactive to any kind of stimuli. It is very well defined by our Ayurvedic classical text books[10–12] that maximum number of diseases will be caused by Vata. Diastolic blood pressure was decreased in VP and PK Prakriti in diabetic exercise group after walking (isotonic exercise) which is statistically significant. Decrease in diastolic blood pressure after exercise may be caused due to decrease in peripheral resistance by producing vasodilatation through accumulation of metabolites like carbon dioxide and hydrogen ion because the diastolic blood pressure is directly affected by peripheral resistance. Systolic blood pressure also falls due to decreased sympathetic discharge after 30 minutes walk for 3 months. Some previous studies have shown that systolic and diastolic blood pressure was decreased after aerobic exercise.[13,14] The present study also confirms the findings of earlier workers. VP Prakriti individuals have greater degree of Raja Dosha than Kapha Dosha. So the individuals are more reactive to any kind of stimuli and prone to develop chronic stress leading to different kind of psychosomatic disorders. In this study maximum number of individuals belonge to VP Prakriti. They were prone different kinds of diseases. The reason for this could be that Pitta is responsible for intelligence and Vata is responsible for initiation and enthusiasm.[15] Pulse is lower when individuals are at rest and increases during exercise (because more oxygen-rich blood is needed by the body when an individual exercises). On intra group comparison after first follow up, a statistically highly significant (P<0.001) decrease in pulse rate was observed in DME after walking (isotonic exercise) whereas it was just significant in PK Prakriti of DME group [Table 4]. As activity level decreases, vasopressin agents that increase heart rate are decreased in a reverse feedback loop of blood pressure homeostasis. Also, the heart rate partly depends on Starling's law, which indicates that the more volume of blood enters the heart, the more will be pumped out. With a lower blood return after exercise, the heart will respond by beating both more slowly and also with less force per beat other study had shown the decreased sympathetic stress after exercise interventions causes decrease in pulse rate. This type of studies could not find till now. Aerobic exercise increases oxygen consumption and improve functioning of the cardiovascular and respiratory systems. Maximum breathing capacity is about 50% greater than actual pulmonary ventilation during maximum exercise. Respiratory rate has been decreased after 3 months of isotonic exercise this result may be due to the fact that the breathing exercises also results in decreased respiratory rate. Some previous studies stated that exercise decreases the respiratory rate if observed immediately. Current study period was three month. As per Table 4, VK Prakriti in DME group showed statistically highly significant (P<0.001) decrease in mean respiratory rate after walking (isotonic exercise). A statistically significant (P<0.05) decrease was observed in VP Prakriti individuals in DME group, PK Prakriti individuals in DME group. VK Prakriti individuals show significant changes in Respiratory rate in group DME. Whereas changes observed in control group were within normal limits. Studies also reported that respiratory rate will not significantly change with Prakriti.[16] With continued moderate exercising, however, muscles take up glucose at almost 20 times the normal rate. This lowers blood sugar levels. Blood glucose levels decreased during periods of exercise due to increased permeability of glucose in peripheral tissues. Glucose levels are the primary cause of cardiovascular and neurological disorders in diabetics. Exercise should primarily be aerobic.[17] In present study remarkable decrease in FBS was observed after walking and FBS is more reliable marker for diabetic individual.[18] Studies reported that fasting blood sugar level decreased after the exercise[18] and it was consistent to this study. VP Prakriti in DMC and DME group [Table 5] showed statistically highly significant change in post-prandial blood sugar level after walking (isotonic exercise).[19] This means blood sugar level can be easily controlled in VP Prakriti individuals. This observation may due to Chala Guna of Vata which promote quick peripheral utilization of glucose. If they discontinue exercise, relapses may be observed. This means PK individuals with Diabetes are easily curable because Kapha Prakriti individuals are having very good compliance. Interpretation can be drawn from the above observation that diabetic patients have better response to exercise than hypertensive patients as per Prakriti. It is very well defined in Ayurvedic text books that in advanced stage Prameha, exercises like physical exercise, wrestling, sports, riding elephant, horse and chariot, travelling on foot and moving around and also feats of archery are to be practiced. Hence, walking is mainly indicated in Madhumeha (diabetes mellitus).[1] It is also mentioned that those who are not doing exercise (physical activity) and taking high-calorie diet are mostly prone for Prameha.[6,7] DM Control group has shown increased post-prandial blood sugar level, it means individuals who did not perform exercise are very prone to develop diabetes. Interpretation can be drawn from this observation that exercise is prophylactic as well as curative treatment during very early stages of diabetes. Total cholesterol levels are lower in persons with high aerobic fitness compared to low aerobic fitness, it has not been conclusively demonstrated that exercise lowers total cholesterol. Measurements made before and after exercise have produced variable results with no clear consensus as to whether or not moderate or vigorous exercise can lower total cholesterol. In studies, where total cholesterol has been significantly reduced, it appears that the activities were more dynamic and vigorous in nature, such as running programs. In contrast to the variable effects of exercise on total cholesterol, endurance exercise consistently lowers triglycerides.[20] A physically active lifestyle may help to prevent age-related rise in triglycerides normally observed in men. It also appears that endurance exercise lowers triglyceride levels more in the patients who had initial baseline levels elevated. Lower triglyceride concentrations in the blood have been attributed to increase in skeletal muscle and adipose tissue lipoprotein lipase activity from aerobic training. Lipoprotein lipase is the key enzyme for the breakdown of triglyceride rich lipoproteins. On a long-term basis, decrease of body fat that often accompanies endurance training may be a contributing factor for this lowering effect of triglycerides due to exercise. Some studies have reported that decreased lipid profile level due to some biochemical changes take place during exercise.[21]