Susruta of India, an unrecognized contributor to the history of exercise physiology

When considering the history of exercise physiology, authors begin with Hippocrates and the “Golden Age” of Greece before mentioning Galen and the contributions from Rome. However, this approach has omitted the information from the ancient civilizations of India which flourished before and during the emergence of Mycenaen cultures. Specifically ignored have been 1) the tridosa doctrine (humoral theory), which as early as 1500 B.C., emphasized that disease occurred because of a displacement of one or more of the three humors, with health being achieved when the humors were in equilibrium and 2) the perspective of Susruta (Sushruta) who was a 600 B.C. physician who included exercise in his prescriptions to prevent and treat diseases. Susruta not only advocated exercise to maintain equilibrium among the humors, notably kapha, he promoted exercise to minimize the consequences of obesity and diabetes. To be effective, exercise had to be daily and moderate in intensity and never excessive or to exceed the half-maximum limit for exhaustion, because disease or even death could ensue. It is concluded that Susruta's concepts pertaining to chronic exercise and to the health benefits of exercise were “remarkably modern” and that future authors on the history of exercise physiology should include contributions from ancient India.