For a substantial proportion of the population in impoverished nations, physical activity is more or less essential to earning a livelihood, rather than being just another activity aimed toward better health. To make ends meet, a subsistence farmer or manual labourer must start early in the morning and work until late in the evening. For example, the tricycle rickshaw is still a means of transport in some places, and the pedaller burns an immense number of calories throughout the day. But at the end of the day, his health may not have improved, despite his supposedly deriving health benefits from aerobic physical activity.1–3 Therefore, it seems that more than physical activity alone is needed.
Instead, various factors probably interact with physical activity to generate the health benefits observed. Although the study by Darren Warburton and associates1 is meticulous, detailed and interesting, the interplay of an adequate balanced diet, timely replenishment of essential minerals and nutrients, the environment, adequate rest, psychological factors, comorbidities and other factors needs to be explored.
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