…the unprecedented high consumption in sedentary environments, with continuous storage of excess energy that would never be physically expended is causing a collapse of the metabolic “feast/famine” experience. This is fuelling the increasing incidence of preventable obesity and chronic diseases.


A proverb in Yoruba language says, “he who accuses a man with a deformed knee of poor posture is certainly not paying attention to his crooked leg.” I am forever fascinated by this proverb as a physiotherapist. Indeed, no competent physiotherapist would waste clinical hours and his/her patient’s precious time in administering postural training to a patient with knock knee, without addressing the primary knee problem, either conservatively with a corrective brace or in an extreme case with the surgical knife of an orthopedist. Either way, resolving the knee problem always resolves the postural problem.

This reminds me of a few rich kids in my undergraduate days at the Obafemi Awolowo University, who genuinely couldn’t tell if African yams were plucked off trees or dug out from the ground. In so many ways, the majority of the world population is as naïve as those rich kids, with no appreciation of the contribution of the locomotor system to human health, fitness and survival. The locomotor system consists of skeletal muscles, bones, joints, ligaments, cartilage and other connective tissues that allow the body to move.

For several generations, foraging or hunting success was never guaranteed but daily physical exertion on the locomotor system was a certainty. However, the locomotor system has been successfully decoupled from the experiences of modern life. Prior to agriculture, food consumption was inseparable from energy expenditure (physical exercise). It took physical efforts to search for food, water and to engage in all other human endeavours. Our forebearers were great migrants who adaptively “live(d) a life of move when you have to and rest when you can” and therefore kept fit on the necessary daily “exercise” to survive. As you are reading this article somewhere, I’m thankfully spared of the tedious physical delivery on your tablet and it would certainly cost you no physical effort to socially initiate and maintain friendship with anyone anywhere in the world today. That is a good example of getting rid of the locomotor system at its best.

We no longer live under the environmental stress associated with food flunctuations in changing climates and seasons. However, the near elimination of the need for the locomotor system and abundant food supply via sophiscated energy-saving devices is at odds with the infrequent food supply over the centuries.


About two months ago, I was priviledged to make a presentation on “Additive Effects of Exercise on Insulin Sensitivity in the Management of Type 2 Diabetes” to the Conference of Nigerian Physical Therapy Alumni held in Dallas, Texas. As I was thinking about the opening remarks for my presentation, it occurred to me that it cost me no extra physical effort from my usual daily activities to travel hundreds of miles from my house to Dallas, Texas. I asked my son, who was with me at the time, to google the distance from my house in Indiana to the hotel site in Dallas by walking.

Wait for this! Let’s assume for a moment that the local committee conference chairperson, Dr. Ajayi, was our paramount tribal chief, several hundred of years ago, and all the Nigerian physiotherapists residing in the United States were his subjects, it would take 11 days and 7 hours for my clan to trek the 822-mile journey from Indiana to attend the annual “tribal gathering” in Dallas, Texas. Obviously this would not include resting times, searching for food or bathroom stops. That would definitely entail enormous planning and untold physical hardship. Thanks to the modern transportation system, the travel time was condensed to a 17-minute drive from my house to the Airport and a 2 hour-21 minute flight to Dallas! With the locomotor system eliminated, snacks and soda drinks were served on the plane, even though no one was probably hungry, given the several eatery places available before and after going through the Airport security. While a lot of us do not travel by air often, humans instinctively choose convenience over physical exertions in everyday lives. This is the reason why teenage kids would send text messages to their parents inside the same house and while a lot of us would get on elevators and avoid the stairs altogether.

We no longer live under the environmental stress associated with food flunctuations in changing climates and seasons. However, the near elimination of the need for the locomotor system and abundant food supply via sophiscated energy-saving devices is at odds with the infrequent food supply over the centuries. Therefore, the unprecedented high consumption in sedentary environments, with continuous storage of excess energy that would never be physically expended is causing a collapse of the metabolic “feast/famine” experience. This is fuelling the increasing incidence of preventable obesity and chronic diseases. According to the Center for Disease Control (CDC), low levels of physical activity contribute to heart disease, type 2 diabetes, some cancers and obesity, not including the associated complications of kidney disease, amputations, hypertension, etc.

In dollar terms, the low level of physical activity is putting a huge burden of about $117 billion dollars on the American health care costs annually. According to the World Health Organisation, physical inactivity is the fourth leading risk factor for global mortality and it is estimated at 3.2 million deaths every year.


While it is so easy to blame grandma for sitting on the couch all day, records show that three out of four U.S. adults do not get enough physical activity and four out of every five high school kids do not meet the required physical activity guidelines. In dollar terms, the low level of physical activity is putting a huge burden of about $117 billion dollars on the American health care costs annually. According to the World Health Organisation, physical inactivity is the fourth leading risk factor for global mortality and it is estimated at 3.2 million deaths every year.

There is no doubt that we should reach for the pills when we have to but we should not have to stay sedentary and wait to medicate preventable illness. You may not be able to walk 30 minutes a day at least five days week, just do what you can and how often you can because everyone benefits from exercise at the level of their physical limitations on the basis of age, disability, disease conditions etc. Don’t blame grandma for inactivity, most of us are equally inactive, if not worse, as we stay glued to the computers on our desk jobs, day in, day out. An 18th century Italian physician, Bernardini Ramazzini, astutely observed that the professional messengers avoided the occupational health hazards of sedentary tailors and cobblers. He was famously quoted as stating: “Let tailors be advised to take physical exercise at any rate on holidays. Let them make the best use they can of some one day, and so to counteract the harm done by many days of sedentary life”. Aren’t we all “tailors” now? We don’t have to be.

Mukaila Kareem, a doctor of physiotherapy and physical activity advocate, writes from the USA and can be reached through makkareem5@gmail.com.